1. Nursing Home Incident Command System
Module 4
Tool Kit: Guidebook, JAS, Forms, and IPGs/IRGs
This module is about the other useful materials that have been included as part of the NHICS Tool Kit – The Guidebook, Job Action Sheets or JAS, the 20 documentation forms and the 6 Incident Planning and Response Guides.

2. This program has been produced by the Center for HICS Education and Training with funding from the California Association of Health Facilities.  The materials contained within are provided for Nursing Homes and other Long Term Care Facilities in development of emergency preparedness and response programs.
Please make note of the message above.

3. OBJECTIVES At the end of this program the participant will:
Be familiar with the Guidebook
Understand the purpose of Job Action Sheets and their utilization
Understand the Eighteen (18) NHICS Forms and how they should be used
Be able to use the six (6) Incident Planning and Response Guides
At the end of this program the participant will:
Understand the purpose of Job Action Sheets and their utilization
Understand the 20 NHICS Forms and how they should be used
Be able to use the six (6) Incident Planning and Response Guides

4. NHICS Guidebook How-to guidance for use of the NHICS
Detailed explanations of the sections, Command and General staff positions
Overview of planning and response guides and tools
Documentation explanation
Implementation guidance
Customization guidance for incorporating the NHICS into your facility
The Guidebook provides guidance for what NHICS is and how to use it.
Each section provides concise but complete details on various aspects of NHICS. Including
- The Command and General Staff positions
- Planning and Response Guides
- Documentation principles
- Implementation guidance
In addition, instructions for how to customize select portions of the NHICS is provided.

5. Using the Guidebook Read it first before getting started
Insure others working on implementation have reviewed it
Share it with other community responders to familiarize them with NHICS
The Florida Healthcare Association –Emergency Management Guide for Nursing Homes is useful tool for completely understanding emergency planning and response
To best understand NHICS and how to implement it in your facility read the Guidebook firs.t
Insure others working on implementation have reviewed it as well.
Sharing it with other community responders such as police , fire/EMS. Public Health and Emergency Management will help to familiarize them with NHICS and hence work more seamlessly with you during training and real world emergency responses.
The Florida Healthcare Association –Emergency Management Guide for Nursing Homes is another useful tool for that is a nice adjunct to completely understanding emergency planning and response and implementing NHICS in a nursing home.

6. WHY ARE JOB ACTION SHEETS IMPORTANT?
Job Action Sheets Provide:
Mission
Summary of the emergency response functional role
Key Contact information
Mechanism to document assigned duties
Time period prompts for each role
During an emergency, staff is often assigned new roles in the Incident Command System that they may not be familiar with. Job Action Sheets provide a written summary of the functional role, its mission, reporting structure, contact information, and timed job expectations for the position.
Job Action Sheets also provide a mechanism to document assigned duties within the operational period, including times and transfer of responsibility.
Job Action Sheets are all-hazard assignments and provide prompts for each distinct time period

7. JAS INFORMATION BOX
The information box at the top of the JAS documents position assignment and KEY response information such as location and contact data
Date: Start: End: Position Assigned to: Initial:
Position Reports to: Incident Commander Signature:
Facility Command Center (HCC) Location: Telephone:
Fax: Other Contact Info: Radio Title:
Each Job Action Sheet has an information box at the top. The information box documents position assignment and KEY response information such as location and contact data

8. CHRONOLOGICAL LIST OF TASKS
The JAS includes a chronological list of tasks to be done in each time frame
Immediate hrs
Intermediate hrs
Extended > 12 hrs
Demobilization / System Recovery
There are different priorities for different times during an emergency activation. To assist the assigned personnel, the JAS includes a chronological list of tasks:
Immediate h
Intermediate h
Extended > 12h
Demobilization / System Recovery
The immediate period is the first two hours of activation and can be a very chaotic and busy time period. Situational status for the incident and Incident Action Planning occur during this time. The Job Action Sheets can provide direction for the functional role during this important period.
The intermediate time period is from hour 2 through 12 and provides direction as the event proceeds.
The Extended time period is from 12 hours of the activation and on. The extended time period is especially helpful in these activations where the incident proceeds beyond the first shift and usually involves change in staff with shift change.
Demobilization and System Recovery is the final chronological period and assists with the functions and processes in demobilizing the response and recovering back to normal, or new normal, operations.

9. JAS JOB TOOLS
The JAS lists job tools – additional items that can facilitate response. Examples include:
Forms
Communication tools such as radios
Documents/Tools
Incident Action Plan
NHICS Form 206 – Staff Medical Plan
NHICS Form 207 – Incident Management Team Chart
NHICS Form 213 – Incident Message Form
Facility emergency operations plan
Facility organization chart
Facility telephone directory
Radio/satellite phone
Facility maps and ancillary services schematics
Vendor support and repair directory
The Job Action Sheets list job tools – additional items that can facilitate response. Examples of the tools include:
Forms
Communication tools such as radios
These items should be kept with the JAS if possible so the user can get all of their needed items at once.

10. CUSTOMIZING THE JAS
The JAS can be customized to the individual Nursing Home during the planning phase
Can add your name and or logo
Modify action statements or tools
It is recommended not to change the title or the mission to facilitate integration with community response
The Job Action Sheets can be reviewed prior to an event and customized to the individual facility. Customization can include adding the facility name and logo, adding or deleting tasks, and other changes that make the tool work for your facility.
What should not be customized is a change in the name of the role or the mission. Since the NHIC system is based on the Incident Command System, using the standardized role names assists in coordination with other Nursing Homes and other response agencies in the community.

11. NHICS Forms 18 forms developed
Consistent with forms used by healthcare, fire/EMS/law and emergency management
Used throughout the activation, mitigation, response and recovery
Are handwritten or keyboarded
Purpose and destination indicated on the form
Documentation is a vital to effectively responding to an emergency regardless of its nature. Properly done it records a variety of information that assists with decision making, information sharing as well as provides medico-legal protection.
To assist with what types of information may need to be recorded and who should do it 20 NHICS forms are included as part of the NHICS materials.
These forms are consistent with the forms used by other response organizations.
They are designed to be used as indicated during activation, mitigation, response and recovery.
The information on a form can be either neatly handwritten or keyboarded.
Each form’s purpose and what to do with it when completed is found on the bottom of each form.

12. NHICS Forms Number Name Purpose NHICS 201
Incident Briefing and Operational Log
Document initial response and actions
NHICS 202
Incident Objectives
Defines the command objectives and key messages
NHICS 203
Org. Assignment List
Documents the IMT positions
NHICS 205
Communications Plan
Documents communication technology and contacts
NHICS 206
Staff Injury Plan
Identifies the care for employees
NHICS 207
Organizational Chart
Illustrative chart of IMT
NHICS 213
Message Form
Documents critical messages and response
NHICS 251
Facility Status Report
Assessment of the facility infrastructure
The unique number, name and purpose of the 20 forms can be seen on this slide

13. NHICS Forms Number Name Purpose NHICS 252 Personnel Time Sheet
Tracks hours worked during the response
NHICS 254
Patient Tracking Form
Identifies patients received at the NH
NHICS 255
Resident Evacuation Tracking Form
Tracks all residents evacuated
NHICS 256
Procurement Summary Report
Documents supplies / equipment procured for the response
NHICS 257
Resource Accounting Record
Tracks the expenditures
NHICS 258
NH Resource Directory
Critical contact information
NHICS 259
Casualty & Fatality Report
Documents injury or death of residents
NHICS 260
Pt Evacuation Form
Documents individual evacuated patient
NHICS 261
IAP Safety Analysis
Directs a safe response
And the remaining forms are noted on this slide.

14. Planning and Response Tools: NHICS Forms
Incident Action Planning (IAP)
Done for each operational period (shift) by Planning Section
Guide to the response
Identifies command objectives : the mission
Identifies strategies and tactics
Assigns and documents roles and responsibilities
Assigns resources
Provides a reference
A critical aspect of response planning is Incident Action Planning.
An Incident Action Plan is similar to a football coaches game plan – for this situation here is the play- the needed resources and who does what.
A Nursing Home IAP is done for each operational period (shift) usually by the Planning Section.
The IAP is a written guidance(game plan) for the IMT to use
Properly done it :
- identifies command objectives or the mission to be achieved.
- Details strategies and tactics to be used to achieve the mission
- Assigns and documents roles and responsibilities
- Assigns resources to be used
- Provides a reference to be referred to during the period to insure needed work is being done according to plan

15. NHICS Forms Only use the forms you need
Despite the number, the “basic” or foundational forms can be completed rapidly
Advantage: clear documentation of times, actions, responsibilities
Advantage: a quality assurance tool
Advantage: can assist in reviewing the response
Advantage: can assist in financial recovery
Some other points to keep in mind about the forms are
- Only use the forms you need- rarely will they all be needed or beneficial
- Despite the number, the “basic” or foundational forms can be completed rapidly (201, 202, 203, 204, 207, 261)
- Among the advantages of use are : clear documentation of times, actions, responsibilities
- They are also a quality assurance tool
- And can assist in reviewing the response
- As well as provide assistance in the financial recovery of your facility after the emergency is over

16. NHICS Forms Customizable but…..
Do not change the name or number of the form
Do place individual facility logos on forms
Do complete some forms (ex.: NHICS 258 Resource Directory) during the planning stage
Do place NH specific guidance on the forms
Routing for forms
Use of internet for documentation
The 20 forms can be customized but to insure needed consistency with other responders and optimize receiving needed assistance
Do not change the name or number of the form
It is OK to place your facility logos on forms
It is important that you do complete some forms (ex.: NHICS 258 Resource Directory) during the planning stage
Do place specific guidance for your facility on the forms for example
Routing for forms
Use of internet for documentation vs. handwrite them

17. EDUCATION AND EXERCISE
It is important to educate staff on Job Action Sheets and Form utilization and include their use in future exercises and activations
Although Job Action Sheets and Forms can be helpful to personnel who have not received training on them prior to the assignment, Job Action Sheets are optimally beneficial when staff has received instruction and practice using them before a real emergency. Prior familiarization with when and how to complete the NHICS forms is also important to insuring proper and timely use.
The more training and practice staff receives on all of the NHICS the tools the more familiar they will be with their use.
Prior familiarization with the Job Action Sheets increases staff awareness of the multiple benefits of their use.

18. Planning and Response Tools
Incident Planning Guides
Identify actions to consider in the planning for hazards most commonly faced by Nursing Homes
Severe Weather
Fire
Earthquake
Power Failure
Flood
Disease Outbreak
Sectioned by phases of emergency management: mitigation, preparedness, response and recovery
Two other important items in the tool chest are the Incident Planning (IPGs) and Incident Response Guides (IRGs)
Incident Planning Guides
- Identify actions to consider in the planning for hazards most commonly faced by Nursing Homes
Severe Weather
Fire
Earthquake
Power Failure
Flood
Disease Outbreak
- They are sectioned by phases of emergency management: mitigation, preparedness, response and recovery

19. Incident Planning Guide: Severe Weather
DOES YOUR EMERGENCY OPERATIONS PLAN ADDRESS THE FOLLOWING ISSUES?
Mitigation & Preparedness
Does your nursing home regularly monitor pre-event weather forecasts and projections?
Does your nursing home participate in pre-event local severe storm response planning with emergency management officials?
Does your nursing home have a plan to initiate severe storm nursing home hardening actions (i.e., protect windows; secure outside loose items; test backup generators; obtain supplemental supplies of essential items (food, water, medications, lighting); protect basement high risk areas; relocate at-risk items to higher levels; activate amateur radio operators, top off fuel tanks, etc.)?
Does your nursing home have plans for loss of power or loss of other utilities and services?
Does your nursing home have a surge capacity plan that includes triggers and criteria for activation?
Does your nursing home have MOUs with fuel suppliers to ensure a supply of fuel for emergency generators and vehicles, if needed?
Does your nursing home identify and/or have MOUs with contractors that can perform repairs after the storm?
Does your nursing home consider relocating hazardous materials/chemical agents to prevent contamination in case of flooding?
Does your Emergency Operations Plan include triggers or criteria for activation of the Emergency Operations Plan, incident command and the command center?
Here is a portion of an IPG for Severe Weather

20. Incident Response Guides
Provides a direction (mission) for the response
Critical actions to be taken when the emergency or disaster strikes
Customize to your facility!
Sectioned by IMT role
Grouped in chronological order
Immediate 0-2 hrs
Intermediate 2-12 hrs
Extended ≥ 12 hrs
The IRG is not used to assist with planning for an incident. Rather it is used by the IMT during a response to a particular type of incident.
The IRG
Provides a direction (mission) for the response
Critical actions to be taken when the emergency or disaster strikes
Can be Customized to your facility!
Is Sectioned by IMT role
is Grouped in chronological response time order
Immediate 0-2 hrs
Intermediate 2-12 hrs
Extended ≥ 12 hrs

21. IRG: Severe Weather
Mission: To safely manage the operations of the nursing home (including providing for the safety of residents, visitors, and staff) during a severe weather emergency such as an ice storm, snowstorm, rain, flooding, etc.
Directions
□ Read this entire response guide and review incident management team chart.
□ Use this response guide as a checklist to ensure all tasks are addressed and completed.
Objectives
□ Account for all residents, visitors and staff.
□ Minimize impact on nursing home operations.
□ Communicate situation to staff, residents, media and community officials.
□ Maintain resident care management and safety.
□ Restore normal operations as soon as feasible.
Here is a partial demonstration of an IRG for Severe Weather.

22. Immediate (Operational Period 0-2 Hours)
COMMAND
(Incident Command):
Activate the nursing home Emergency Operations Plan
Activate Command Staff and Section Chiefs, as appropriate
Communicate with local emergency management of nursing home situation status, critical issues and resource requests
Communicate with local EMS and ambulance providers about the situation and possible need to evacuate or relocate residents
Communicate with other health care facilities to determine:
Situation status
Surge capacity
resident transfer/bed availability
Ability to loan needed equipment, supplies, medications, personnel, etc.
This slide demonstrates how the IRG is formatted by time period and IMT role – each command position has suggested activities to consider implementing.

23. SUMMARY
The NHICS has a number of Tools to assist those in charge succeed in their roles
The JASs are a “brain teaser” and documentation tool for each command role
The 18 forms provide assistance in capturing key action taken and promote information sharing
The IPGs and IRGs promote planning and response decision making
Each tool requires training for proper use
You have the option of customization
In summary
- The NHICS has a number of Tools to assist those in charge succeed in their roles
- The JASs are a “brain teezer” and documentation tool for each command role
- The 20 forms provide assistance in capturing key action taken and promote information sharing
- The IPGs and IRGs promote planning and response decision making
- Each tool requires periodic training for proper use
- And your facility has the option of modifying these tools with your name and logo as well as making other content changes as needed so long as basic name and content elements are not lost

24. Module 4 - Self Evaluation QUESTIONS
1. Which of the following is a true statement?
A. Job Action Sheets are only used by fire
and police personnel
B. Job Action Sheets are tools used to help provide critical actions to take during the emergency response
C. Job Action Sheets are hard to use
D. Job Action sheets cannot be changed

25. Module 4 - Questions
2. Which of these is not a time period on the Job Action Sheet? A. Immediate B. Intermediate C. Extended D. Next Day

26. Module 4 - Questions
3 . Which of the following is true about NHICS forms
A. They should be completed neatly and
completely
B. There are 18 forms
C. The purpose and destination is on the form
D. All of the above

27. Module 4 - Questions 4. The Incident Planning Guide is:
A. Written during an emergency
B. Used by the Incident Commander
C. Used for writing/reviewing a response plan
D. Not usually needed for a response

28. Module 4 - Questions 5. The Incident Response Guide
Is used only for planning for a response
Is written for the Administrator on call to use
Is written to assist in managing an incident
None of the above

29. Module 4 - Questions 6. The NHICS Guidebook:
A. Outlines the concepts of NHICS
B. Is written to assist with NHICS implementation
C. Describes the Incident Management
Team position roles and responsibility
D. All of the above