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Application ofIncident Action Plan & Forms:
Chemical Attack
Hospital IncidentCommand System
This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital AssociationThis course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U. . !epartment of Health " Human ervices Assistant ecretaryfor Preparedness " #esponse Hospital Preparedness Program and awarded by the California !epartment of Public Health. $o part of this course or its materials shall becopied or utili%ed for monetary gain.
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• Demonstrate the Incident Action PlanningProcess
• Demonstrate the use of HICS Forms
• Implement the use of the Incident Response
Guides
Objectives
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Scenario Based Implementation
• Discuss and rehearse practicalimplementation of the Incident ActionPlanning process utili!ing HICS forms andthe Incident Response Guides
• "tili!e a #$a%le $op& learning process
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Incident Action Planning
1( Assess the Situation
2( Set the )perational Period
( Determine Safet* Priorities + ,sta%lish Incident)%-ecti.es
'( Determine /ranch0Section )%-ecti.es
( Determine Strategies + $actics
( Determine 3eeded Resources
4( Issue Assignments
5( Implement Actions
6( Reassess + Ad-ust Plans
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Scenario
• $he "ni.ersal Ad.ersar* terrorist group releasesSarin into the .entilation s*stems of three largecommercial office %uildings( 7ithin minutes8people de.elop runn* nose8 9ater* e*es8coughing8 chest tightness8 %lurred .ision8drooling and s9eating( Some de.elop se.eremuscle t9itching8 confusion8 nausea and.omiting( :an* ha.e died(
• People are self e.acuating the %uilding and thereare numerous fall0crush in-uries( ,:S hasinitiated triage and performing decontaminationoutside of the %uildings(
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• /ased on the s*mptoms8 ,:S re;uests large;uantities of ner.e agent antidotes to %e %roughtto the scene( Ha!mat confirms Sarin is thecausati.e agent(
•
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Scenario• $ime> ?5 ?
• 7eather> Clear8 5@ F8 no 9inds
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• 7ithin 1 minutes large num%ers ofcontaminated and 9orried 9ell are presenting
to the hospital for care(• 3um%er of .ictims e pected to arri.e> "n=no9n
Is this an incident?
What are your first actions?Who is in charge?
First Actions
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• "se HICS form 21'> )perational Bog
• Complete HICS form 2?1> Incident /riefingEvent History and Current Actions Summary
• /egin form 2?2> Incident )%-ecti.esWeather/environmental implications for period
Step : Assess t!e Sit"ation
Incident Action Planning
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#!ic! Positions to Activate$
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Immediate %ime Period
Position Immediate Intermediate Extended Recovery
Incident Commander X X X XPublic Information O cer X X X XLiaison O cer X X X XSafety O cer X X X XMedical-Technical Specialist:Chemical
X X X X
Operations Section Chief X X X XMedical Care !ranch "irector X X X XInfrastructure !ranch "irector X X X XSecurity !ranch "irector X X X X#a$Mat !ranch "irector X X X XPatient %amily &ssistance!ranch "ir'
X X X
Planning Section Chief X X X X(esources )nit Leader X X X XSituation )nit Leader X X X X"ocumentation )nit Leader X
Logistics Section Chief X X X X
Ser*ice !ranch "irector X X XSupport !ranch "irector X X X XLabor Pool + Credentialin, )nitLeader
X X X X
Finance /AdministrationSection Chief
X X X
Time )nit Leader X X XProcurement )nit Leader X X XCompensation Claims )nitLeader
X X
Cost )nit Leader X X X
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• $he Incident Commander names theincident
• If the incident is a communit* %asedincident8 the appropriate -urisdiction 9illname the incident e(g(8 count*8 cit*8 ,:SE
• $he incident name should %e documentedon all forms
aming t!e Incident
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• HICS form 2?2> Incident )%-ecti.esOperational Period ate/!ime
• Incident Commander sets the )perationalPeriod
"ased on num#er of simultaneous activities
Ho$ %uic&ly the situation is changing
• An )perational Period %rea=s the incidentdo9n into managea%le timeframes
Step ': Set t!e Operational Period
Incident Action Planning
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• Identif* Incident )%-ecti.es these are theo.erarching o%-ecti.es that 9ill last throughoutthe 9hole responseE
• HICS form 2?2> Incident )%-ecti.es
Step (: )etermine Safety Priorities& Incident Objectives
Incident Action Planning
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*tili+e t!e Incident ,esponse -"ide
Chemical Incident:
Pro*ide safe and e.ecti*e decontaminationof incomin, contaminated patientsProtect patients/ sta./ and the hospital fromcontamination and safely restore normal
operationsCommunicate e.ecti*ely 0ith the local1mer,ency Operations Center andemer,ency response partners
Control Objectives
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It !as been (. min"tes since t!e event:• Appro imatel* '? am%ulator* self transported
.ictims ha.e arri.ed at the hospital claiming to
%e in the .icinit* of the release(• Hospital decontamination set up is complete and
decontamination has %een started(
• ,:S reports the* ha.e appro imatel* ? .ictimsin moderate to se.ere distress( Fielddecontamination is in process( $here areun=no9n num%ers minor e posed0contaminated(,:S is read* to transport ' critical .ictims(
Scenario *pdate /
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• Assess the Safet* issues
• 7hat ha!ards e ist and 9hat precautions needto %e ta=en
Potential contamination of the facility' activatelimited access
Ensure safety of staff receiving victims'appropriate PPE
Potential of hospital to #e over$helmed #yincoming victims' insure security response
• Complete form 21 A Incident Action PlanSafet* Anal*sis
Side ote:Safety Officer %as0s
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• Prepare a statement for the media
• Prepare a statement for the staff8 patients and
.isitors e(g(8 situation8 status8 safet*precautions8 ne t update timeE
• $he statements need appro.al from the IncidentCommander
• Coordinate consistent messaging 9ith the ointInformation Center ICE
Side ote:P"blic Information Officer %as0s
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• 7ho or 9hat entit* operates as the count*contact0:H)AC8 and ho9 do *ou ma=e contact
• 7ho else should %e notified of the situation
• 7ho should %e notified of hospital status /edstatus Decontamination capa%ilit* Ho9
• 7ho is the source of go.ernment resources in
*our local plan e(g(8 Fire department8 local ,:SDepartment )perations Center D)CE8 PHD D)C8Count*0Cit* ,mergenc* )perations CenterE
• e* contacts should %e determined prior to theincident
Side ote:1iaison Officer
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• "tili!e HICS forms
• Form 21' )perational Bog
Side ote:)oc"menting yo"r Actions
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• Document on HICS 2?' Assignment Bist
• $he* are %ased on the Incident )%-ecti.es
• $hese are %ased on 9hat is desired to %eachie.ed %* the Section in that operationalperiod
• )%-ecti.es need to %e S:AR$ Simple8:easura%le8 Achie.a%le8 Realistic8 $imeSensiti.e + $as= )rientedE
Incident Action Planning
Step 2: )etermine Branc!3Section Objectives
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• A common pro%lem during e ercises is thatSections0/ranches donJt de.elop theiro%-ecti.es promptl*
• Report top o%-ecti.es
Branc!3Section Objectives
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• Strategies + tactics are ho9 *our /ranch0Sectionis going to achie.e the o%-ecti.es
• 7hat actions do *ou need to ta=e
• "se *our facilit* response plans and IncidentResponse Guides
• Record strategies + tactics on form 2?' /ranch Assignment Bist
Incident Action PlanningStep 4: )etermine Strategies & %actics
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• Does additional space need to %e acti.ated• 7hat personnel resources do *ou need
• 7hat e;uipment and0or supplies0 pharmaceuticalsdo *ou need• 7hat resources do *ou need in the patient
collection0decontamination area
• 7hat communication de.ices do *ou need• Document resource acti.ities>
(esources assigned )form *+,-(esource re%uests )form *. -
Actions ta&en to utili0e 1 o#tain resources (form 214)
Step 5: )etermine eeded ,eso"rcesIncident Action Planning
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• 7ho 9ill %e assigned to the units
• Fill in the assignments on form 2?' Assignment Bist
• Are there other %ranches that need acti.ated
Step 6: Iss"e Assignments
Incident Action Planning
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• For the first )perational Period the Incident Action Plan should %e done
9ithin ? ' minutes
• 7hat ma=es up the Incident Action Plan
2orm *+. 3 Incident "riefing
2orm *+* 3 Incident O#4ectives 2orm *+ 3 Incident Assignments 2orm *+, 3 "ranch Assignments 2orm *.5A 3 Incident Action Plan Safety Analysis
• $he Planning Section compiles the forms to create the Incident Action Plans
Incident Action Planning
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IAP 7"ic0 Start
• 3e9 form
• Can %e used for small incidents
• )r for a rapid start to a large incident andthen e pand out on indi.idual HICS forms
• Great for smaller pre planned e.ents
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IAP Cover S!eet
• Can %e used for the IAP Kuic= Start or fullIncident Action Plan forms
• Can ma=e different colors if *ou 9ant todifferentiate )perational Periods
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• Put *our acti.ities 0 plans into action
• 7hat are some of these acti.ities
Step 8: Implement Actions
Incident Action Planning
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• It is no9 1??? 1( hrs into the incident
• $he hospital has recei.ed ? additionalam%ulator* self transported .ictims8 ' in se.eredistress and 1? in moderate distress
• Decontamination of .ictims continues
• ,:S has transported 2 critical .ictims to *our
hospital• 7hat are *our ma-or concerns
Scenario *pdate /'
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• $o9ards the end of the operational period8 *ou 9illneed to e.aluate status
• Repeat steps 1 5
• "pdate the forms
• ,.aluate and0or update *our /ranch0Section)%-ecti.es
• $his creates *our Incident Action Plan game planEfor the ne t operational period
Step 9: ,eassess & Adj"st Plans
Incident Action Planning
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• It is no9 ' hours into the incident
• All .ictims ha.e %een transported
• Hospital decontamination is completed and thereis a large .olume of .ictim %elongings and gre*9ater collection
• "ni.ersal Ad.ersar* has claimed responsi%ilit*and states a secondar* de.ice is in place
• 7hat issues should %e considered
Scenario *pdate /(
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7hat are things 9e need to remem%er to doShare information
(ecovery / (estoration
After Action (eport
Corrective Actions Plan
Ho are e doing$
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7"estions$
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de.eloped %* theCalifornia Hospital AssociationJsHospital Preparedness Program
999(calhospitalprepare(org
Application ofIncident 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 AssociationThis course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U. . !epartment of Health " Human ervices Assistant ecretary
for Preparedness " #esponse Hospital Preparedness Program and awarded by the California !epartment of Public Health $o part of this course or its materials shall be