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HOSPITAL INCIDENT COMMAND SYSTEM

Incident Action Planning

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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OBJECTIVES

• Understand the 9 steps of the Incident Action Planning process

• Identify Incident Action Plan components

• Exercise the development of an Incident Action Plan

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INCIDENT MANAGEMENT: TEAM REVIEW

Operations Section Chief

Planning Section Chief

Logistics Section Chief

Finance / Administration Section Chief

Incident Commander

PublicInformation

Officer

LiaisonOfficer

Medical/Technical

Specialist(s)

SafetyOfficer

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HOSPITAL INCIDENT ACTION PLANNING

Key to Effective

Response and Recovery

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1. Assess the Situation

2. Set the Operational Period

3. Determine Safety Priorities & Establish Incident Objectives

4. Determine Branch/Section Objectives

5. Determine Strategies & Tactics

6. Determine Needed Resources

7. Issue Assignments

8. Implement Actions

9. Reassess & Adjust Plans

INCIDENT ACTION PLANNING

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•Type of incident, location, magnitude, and possible duration•Ongoing hazards and safety concerns•Determines initial priorities based on:

1) Life saving 2) Incident stabilization 3) Property preservation

•Establishes the Hospital Command Center

The Incident Commander conducts the initial incident assessment from the information gathered:

1) ASSESS THE SITUATION

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An Operational Period is: • The period of time scheduled for execution of a

given set of tactical actions in the Incident Action Plan

• Set by the Incident Commander

The Operational Period is usually set in hours:

• Does not have to conform to shift times

• Can be long or short, depending on the intensity of the incident or amount of information available

2) SET THE OPERATIONAL PERIOD

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General Command Objectives are:• Broad organizational objectives that are

foundational and do not change during response and recovery. These objectives define where the system wants to be at the end of the response

• Not limited to an Operational Period

Examples:• Provide adequate care to all patients who present

as a result of the incident

• Provide for the safety of staff, patients and visitors

3) DETERMINE SAFETY PRIORITIES & ESTABLISH INCIDENT OBJECTIVES

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Section/Branch Objectives are:• More specific objectives to achieve overall

incident objectives

• Steps during the defined Operational Period

• Should be tangible and measurable

Example:• Provide prophylaxis to 75% of hospital staff in

this operational period

• Decontaminate 25 victims in 2 hours

4) DETERMINE SECTION/BRANCH OBJECTIVES

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5) DETERMINE STRATEGIES AND TACTICS

Strategy Defined:• The general direction selected to accomplish

incident objectives (NIMS)

• The approach to achieving the objectives

Tactics Defined:• Specific actions, sequence of actions,

procedures, tasks, assignments to meet strategies and objectives

• The “boots on the ground” or “doers”

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• Tactical resources may include: Personnel Equipment Supplies Pharmaceuticals Vehicles

• Available and needed resources to meet the tactical objectives must be identified

6) DETERMINE NEEDED RESOURCES

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• Additional HICS positions are activated according to incident needs

• Staff are assigned to conduct incident specific operations:

Evacuation Decontamination Triage and treatment Safety measures

Once the tactical objectives and necessary resources are identified, assignments are issued:

7) ISSUE ASSIGNMENTS

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THE INCIDENT ACTION PLANNING MEETING

The Incident Action Planning Meeting is:

• Led by the Planning Chief

• Defines and finalizes branch/section objectives, strategies, tactics, and resources as determined by each section for the next operational period

• The Section Chiefs submit completed HICS Form 204 Branch Assignment List and the Safety Officer submits completed HICS Form 215A IAP Safety Analysis

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Direct, monitor and evaluate response efforts:

• Constant monitoring of strategies and tactics for effectiveness

• Assess the Operational Period Objectives Are the objectives being achieved? Is the strategy/tactics safe? Is the strategy/tactics effective?

• Evaluation is an ongoing process throughout response and recovery

8) IMPLEMENT ACTIONS

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9) REASSESS & ADJUST PLANS

Conduct a Current Situation Assessment:

Update situation/incident information Assess the impact on the hospital Length and duration of continued/resolving

incident Resource availability

• Assess the Incident Objectives

• Make sure they are achieved in a safe and timely manner

• Revise objectives, strategies, tactics and resource needs for the upcoming operational period

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INCIDENT ACTION PLAN RESPONSIBILITIES

The Incident Commander:• Provides general Command and

Control Objectives (HICS 202 Incident Objectives)

• Sets the Operational Period

• Develops major strategies (priorities)

• Activates Incident Management Team positions

• Establishes policy for resource orders

• Approves initial actions and the completed Incident Action Plan

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The Safety Officer:

• Advises the Incident Commander and Section Chiefs on safety issues and measures

• Develops the Safety Plan (HICS 215A Incident Action Safety Plan Analysis)

• Oversees the safety of operations and tactics

INCIDENT ACTION PLAN RESPONSIBILITIES

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The Planning Section Chief:• Prepares for the Planning Meetings

Gathers information for the Incident Action Plan (HICS 201, 202, 203, 204’s and 215A)

Develops demobilization plan

• Conducts the Planning Meeting

• Coordinates and submits the Incident Action Plan to the Incident Commander for approval

• Disseminates the Incident Action Plan

INCIDENT ACTION PLAN RESPONSIBILITIES

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The Operations Section Chief:

• Determines/assesses areas of operation

• Advises Incident Commander of activated Operations positions and work assignments

• Determines tactics (HICS 204)

• Determines resource requirements (HICS 204) and communicates needs with Logistics

INCIDENT ACTION PLAN RESPONSIBILITIES

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The Logistics Section Chief:

• Ensures resource ordering meets the needs

• Advises Incident Commander on activated Logistics positions

• Ensures resources to support the Incident Action Plan

• Develops plans that support the Incident Action Plan

Communications Plans Transportation Plans

INCIDENT ACTION PLAN RESPONSIBILITIES

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The Finance/Administration Section Chief:

• Provides cost implications of the Command and Control, and Operational Period Objectives

• Ensures the Incident Action Plan is within cost limitations

• Advises the Incident Commander on Finance/Admin activated positions

INCIDENT ACTION PLAN RESPONSIBILITIES

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The Incident Action Plan:

• Provides Incident Management Team personnel with direction for the Operational Period

• Incident Action Planning is a process of Management by Objectives

• Essential for effective response and recovery

INCIDENT ACTION PLAN SECTION REVIEW

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QUESTIONS?

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Incident Response Guides

• Active Shooter 

• Chemical Incident

• Earthquake 

• Evacuation, Shelter-in-Place, & Hospital Abandonment

• Explosive Incident

• Hostage or Barricade Incident

• Infectious Disease 

There are 16 Scenario-based Incident Response Guides :

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Incident Response Guides (continued)

• Information Technology (IT) Failure 

• Mass Casualty Incident

• Missing Person 

• Radiation Incident 

• Severe Weather with Warning

• Staff Shortage 

• Tornado 

• Utility Failure 

• Wildland Fire 

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Provides Incident-specific:• Directions

• Incident Objectives

• Management tasks by function and timeframes

• Sample Hospital Incident Management Teams

Should compliment:

• Emergency Operations Plan and Job Action Sheets

Can be used as documentation

Incident Response Guides

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HICS FORMS USED IN THE INCIDENT ACTION PLAN

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HICS Form 200Incident Action Plan Cover Sheet

• Purpose: Provides a cover sheet and a checklist for HICS Forms and other documents included in the operational period Incident Action Plan

• Origination: Incident Commander or Planning Section Chief

• Copies to: Command and General Staff and Documentation Unit Leader

• Helpful Tips: Additions may be made to the form to meet the organization’s needs

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HICS Form 201 Incident Briefing

• Purpose: Documents initial response information & actions at start-up

• Origination: Incident Commander

• Copies to: Command Staff, Section Chiefs, and Documentation Unit Leader

• When to Complete: Prior to briefing the current operational period

• Helpful Tips: Distribute to all staff before initial briefing

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HICS Form 201Incident Briefing

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• Purpose: Defines incident objectives

• Instructions: Include -Weather/Environmental Implications General Safety/Safety MessagesAttachmentsPrepared by Planning Section ChiefApproved by: Incident Commander

HICS Form 202Incident Objectives

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HICS Form 202Incident Objectives

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• Purpose: To document Hospital Command Center staffing

• Origination: The Planning Section Chief or designee (Resources Unit Leader)

• Copies to:

Command Staff and General StaffBranch Directors and Agency StaffDocumentation Unit Leader

HICS Form 203:Organizational Assignment List

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HICS Form 203:Organization Assignment List

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• Purpose: Document branch assignments, objectives, strategies/tactics and resource needs

• Origination: Section Chief or Branch Director

• Copies to: Command, General Staff and Documentation Unit Leader

• Prepared by: Branch Director

• When to complete: At the start of each operational period

HICS Form 204: Assignment List

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HICS Form 204: Assignment List

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HICS Form 215A: Incident Action Plan Safety Plan Analysis

• Purpose: Document hazards and mitigation

• Origination: Safety Officer

• Copies to: Command and General Staff, Sections, and Branches

• Prepared by: Safety Officer

• Approved by: Incident Commander

• When to complete: Prior to safety briefing during the Operations Briefing and at transfer of role

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HICS Form 215A: Incident Action Plan Safety Plan Analysis

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• Purpose: Document

Incident issues encountered Decisions made Notifications conveyed

• Origination: Command and General Staff

• When to complete:

Continuously, from activation through demobilization

HICS Form 214:Activity Log

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HICS Form 214:Operational Log

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Purpose: A short form combining forms 201, 202, 203, 204 and 215A. May be used in place of full forms to document initial actions or short incidents, and can expand to the full forms as needed.

Origination: Incident Commander or Planning Section Chief

HICS Form IAP Quick Start

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HICS Form IAP Quick Start

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Application of Incident Action Plan –

Infectious Disease

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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Incident Action Planning

1. Assess the Situation

2. Set the Operational Period

3. Determine Safety Priorities & Establish Incident Objectives

4. Determine Branch/Section Objectives

5. Determine Strategies & Tactics

6. Determine Needed Resources

7. Issue Assignments

8. Implement Actions

9. Reassess & Adjust Plans

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• Influenza season has begun and hospitals and primary care see an increase in the number of influenza-like illness (ILI) cases presenting for care including a family of 5 with symptoms of ILI.

•  Emergency departments and community health centers see a surge in ILI cases presenting, and admissions increase over 10% with acute respiratory illnesses.

• PHD is stating there is evidence of an emerging infectious disease with respiratory spread and that hospitals should prepare for significant surge.

Scenario

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First Actions

• Time: 0900

• Weather: Clear, 68º F, no winds

Is this an incident?

What are your first actions?

Who is in charge?

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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?

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Immediate Time Period

Position Immediate Intermediate Extended Recovery

Incident Commander X X X XPublic Information Officer X X X XLiaison Officer X X X XSafety Officer X X X X

Operations Section Chief X X X XMedical Care Branch Director X X X XInfrastructure Branch Director X X X XSecurity Branch Director X X X XBusiness Continuity Branch Director XPatient Family Assistance Branch Dir. X

Planning Section Chief X X X XResources Unit Leader X X X XSituation Unit Leader X X X XDocumentation Unit Leader X X XDemobilization Unit Leader X X

Logistics Section Chief X X X XService Branch Director X X X XSupport Branch Director X X X X

Finance /Administration Section Chief X X X XTime Unit Leader X X XProcurement Unit Leader X X XCompensation/Claims Unit Leader XCost Unit Leader X X X

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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 o Based on number of simultaneous activitieso 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 the Incident Objectives (these are the broad objectives that will last throughout the response or are the priorities)

• HICS form 202: Incident Objectives

Step 3: Determine Safety Priorities & Establish Incident Objectives

Incident Action Planning

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Utilize the Incident Response GuideInfectious Disease:

• Identify, triage, isolate and treat infectious patients

• Protect patients and staff from exposure and injury

• Assure safety and security for patients, staff, visitors and the hospital

• Admit a large number of infectious patients while protecting other (uninfected) patients

Incident Objectives

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• It is reported the several of the patients with ILI symptoms in your hospital are requiring ICU level care and ventilator support.

Scenario Update #1

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• Assess the Safety issues

• What hazards exist and what precautions need to be taken

• Complete the 215A – 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 task

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• Make contact with the Public Health Department, EMS Agency or through the local EOC (MHOAC) if activated

• Who should be notified?

• 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)

• These contacts/processes should be identified prior to any incident

Side Note: Liaison Officer

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• Utilize HICS forms

• 214 - Operational Log

Side Note: Documenting your Actions

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• Document on HICS 204 – Assignment List

• They are based on the Incident Objectives

• These are based on what is desired to be achieved by the Branch/Section in that operational period

• Objectives need to be SMART (Simple, Measurable, Achievable, Realistic, Time Sensitive & Task Oriented)

Incident Action Planning

Step 4: Determine Branch/Section Objectives

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• Review IRG

Branch/Section Objectives

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• Strategies & tactics are how your Branch/Section 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 –Assignment List

Incident Action PlanningStep 5: Determine Strategies & Tactics

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• What space resources are needed?

• 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)

Step 6: Determine Needed Resources

Incident Action Planning

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• Who will be assigned to the units?

• Fill in assignments on form 204 – Assignment List

• Are there other branches or units 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? 201 - Incident Briefing 202 - Incident Objectives 203 - Incident Assignments 204 - Branch Assignments 215A - Incident Action Plan Safety Analysis

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

Incident Action Planning

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IAP Quick Start

• New form

• Can be used for small incidents

• Or for a rapid start to a large incident and then expand out on individual HICS forms

• Great for smaller pre-planned events

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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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• Your hospitals ICU is at full capacity. Patients will ILI symptoms continue to arrive at a high rate. There are only 3 ventilators left available in the hospital.

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 Branch/Section 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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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?