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Application of Incident Action Plan & Forms:

Chemical Attack

Hospital Incident Command System

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.

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• Demonstrate the Incident Action Planning Process

• Demonstrate the use of HICS Forms

• Implement the use of the Incident Response Guides

Objectives

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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

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Incident Action Planning

1. Assess the Situation

2. Set the Operational Period

3. Determine Safety Priorities & Establish Control Objectives

4. Determine Operational Period Objectives

5. Determine Strategies & Tactics

6. Determine Needed Resources

7. Issue Assignments

8. Implement Actions

9. Reassess & Adjust Plans

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Scenario

• The Universal Adversary terrorist group releases Sarin into the ventilation systems of three large commercial office buildings. Within minutes, people develop runny nose, watery eyes, coughing, chest tightness, blurred vision, drooling and sweating. Some develop severe muscle twitching, confusion, nausea and vomiting. Many have died.

• People are self evacuating the building and there are numerous fall/crush injuries. EMS has initiated triage and performing decontamination outside of the buildings.

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• Based on the symptoms, EMS requests large quantities of nerve agent antidotes to be brought to the scene. Hazmat confirms Sarin is the causative agent.

• Your hospital is the closest hospital about 2 miles from the scene. Many victims self evacuate and drive to your hospital. EMS also begins transporting the most critical victims to your facility with a short ETA. It is unknown if the victims have been fully decontaminated.

Scenario

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Scenario

• Time: 0830

• Weather: Clear, 68º F, no winds

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• Within 15 minutes large numbers of

contaminated and worried well are presenting to

the hospital for care.

• Number of victims expected to arrive: Unknown

Is this an incident? What are your first actions? Who is in charge?

First Actions

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• 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

Step 1: Assess the Situation

Incident Action Planning

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Which Positions to Activate?Incident Commander

Planning Section Chief

LogisticsSection Chief

Operations Section Chief

Finance/

Administration Section Chief

Liaison Officer

Medical/Technical Specialist

Safety Officer

Public Information Officer

Procurement Unit Leader

Compensation/Claims

Unit Leader

Time Unit Leader

Cost Unit Leader

Service Branch Director

Support Branch Director

Resources Unit Leader

Situation Unit Leader

Documentation Unit Leader

Demobilization Unit Leader

Staging Manager

Medical Care Branch Director

Infrastructure Branch Director

HazMat Branch Director

Security Branch Director

Business Continuity

Branch Director

Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit

Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit

Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit

Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit

Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit

Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging Team

Personnel TrackingMateriel Tracking

Patient TrackingBed Tracking

Communications UnitIT/IS UnitStaff Food & Water Unit

Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit

Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist

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Immediate Time Period

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• 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

Naming the Incident

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• 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

Step 2: Set the Operational Period

Incident Action Planning

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• Identify Command & Control Objectives (these are the overarching objectives that will last throughout the whole response)

• HICS form 202: Incident Objectives

Step 3: Determine Safety Priorities & Control Objectives

Incident Action Planning

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Utilize the Incident Response Guide

Chemical Attack:

• Identify, triage, isolate and treat contaminated/ exposed patients

• Safely admit a large number of contaminated/exposed patients while protecting your staff and facility

• Accurately track patients through the healthcare system

• Assure safety and security of the facility

Control Objectives

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It has been 30 minutes since the event:• Approximately 40 ambulatory self-transported

victims have arrived at the hospital claiming to be in the vicinity of the release.

• Hospital decontamination set up is complete and decontamination has been started.

• EMS reports they have approximately 50 victims in moderate to severe distress. Field decontamination is in process. There are unknown numbers minor exposed/contaminated. EMS is ready to transport 4 critical victims.

Scenario Update #1

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• Assess the Safety issues

• What hazards exist and what precautions need to be taken Potential contamination of the facility, activate

limited access

Ensure safety of staff receiving victims, appropriate PPE

Potential of hospital to be overwhelmed by incoming victims, insure security response

• Complete form 261 – Incident Action Plan Safety Analysis

Side Note: Safety Officer Tasks

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• 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)

Side Note: Public Information Officer Tasks

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• 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? Decontamination capability? How?

• Who is the source of government resources in your local plan? (e.g., Fire department, local EMS Department Operations Center (DOC), PHD DOC, County/City Emergency Operations Center)

• Key contacts should be determined prior to the incident

Side Note: Liaison Officer

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• Utilize HICS forms

• Form 214 - Operational Log

Side Note: Documenting your Actions

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• 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)

Incident Action PlanningStep 4: Determine Operational Period Objectives

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• A common problem during exercises is that Sections/Branches don’t develop their objectives promptly

• Report top 3 objectives

Operational Period Objectives

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• 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

Incident Action PlanningStep 5: Determine Strategies & Tactics

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• Does additional space need to be activated?• What personnel resources do you need?

• What equipment and/or supplies/ pharmaceuticals do you need?

• What resources do you need in the patient collection/decontamination area?

• What communication devices do you need?

• Document resource activities: Resources assigned (form 204) Resource requests (form 213) Actions taken to utilize & obtain resources (form 214)

Step 6: Determine Needed Resources

Incident Action Planning

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• Who will be assigned to the units?

• Fill in the assignments on form 204 – Branch Assignment List

• Are there other branches that need activated?

Step 7: Issue Assignments

Incident Action Planning

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• For the first Operational Period the Incident Action

Plan should be done within 30-45 minutes

• What makes up the Incident Action Plan?

Form 201 - Incident Briefing Form 202 - Incident Objectives Form 203 - Incident Assignments Form 204 - Branch Assignments Form 261 - Incident Action Plan Safety Analysis

• The Planning Section compiles the forms to create the Incident Action Plans

Incident Action Planning

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• Put your activities / plans into action

• What are some of these activities?

Step 8: Implement Actions

Incident Action Planning

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• It is now 1000 – 1.5 hrs into the incident

• The hospital has received 60 additional ambulatory self-transported victims, 4 in severe distress and 10 in moderate distress

• Decontamination of victims continues

• EMS has transported 2 critical victims to your hospital

• What are your major concerns?

Scenario Update #2

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• 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

Step 9: Reassess & Adjust Plans

Incident Action Planning

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• It is now 4 hours into the incident

• All victims have been transported

• Hospital decontamination is completed and there is a large volume of victim belongings and grey water collection

• Universal Adversary has claimed responsibility and states a secondary device is in place

• What issues should be considered?

Scenario Update #3

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What are things we need to remember to do? Share information

Recovery / Restoration

After Action Report

Corrective Actions Plan

How are we doing?

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Questions?

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developed by the

California Hospital Association’s

Hospital Preparedness Program

www.calhospitalprepare.org

Application of Incident Action Plan & Forms:

Chemical Attack

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.