Hospital Incident Command System - Typepad HICS...Hospital Incident Command System Education ••...
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Hospital Incident Command System Education Mississippi Hospital Association Hattiesburg · Madison · Starkville Center for HICS Education and Training 1 Hospital Incident Command System
Transcript of Hospital Incident Command System - Typepad HICS...Hospital Incident Command System Education ••...
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Mississippi Hospital AssociationHattiesburg · Madison · Starkville
Center for HICS Education and Training1
Hospital
Incident Command
System
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• All technology to silent or vibrate• If you must take or make a call or text
– Wait for a break or– Leave the room for calls
• We will have breaks during the course –please stay within announced timeframe
• Restroom locations• Emergency exits
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• There will be time for questions and answers
• This is intended to be an interactive session
• Your input is important to a successful class
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Why are you here today?
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• Discuss the roles and relationships of the Hospital Incident Management Team
• Discuss the changes/revisions to HICS• Demonstrate the use of HICS tools in
overall planning, response and recovery• Describe the principles of Incident
Action Planning
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The Center for HICS Education and Training
• Collaborative effort between Washington Hospital Center and Kaiser Permanente
• Our mission is to provide information, education and training on HICS
• The Center’s Advisory Board consists of National Workgroup and Ex-officio members from the HICS project
• The Center sponsors a webpage for additional info, HICS materials and updates on HICS utilization www.hicscenter.org
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• Course materials are proprietary and cannot be duplicated, reproduced or utilized without written permission of The Center
• No cameras, video taping or recording of this program are permitted
• Course materials are available on The Center website– Materials can be used for attendee facility
education only– Materials may not be used for profit
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• National Incident Management System• Assistant Secretary for Preparedness and
Response (ASPR)• Centers for Medicare & Medicaid Services
(CMS)
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• The Joint Commission on the Accreditation of HealthCare Organizations (TJC)
• American College of Surgeons• National Fire Protection Association
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Hospital Incident
Command System
(HICS)
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▪ Common command structure▪ Common terminology/clear text▪ Flexible and scalable with a modular
organization▪ Manageable span of control▪ Resource management ▪ Management by objectives▪ Incident Action Planning
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• Component of an Emergency Operations Plan/Emergency Management Program
• Adapted to hospital specific needs and capabilities
• Consistent with traditional ICS terminology in titles and positions
• Uses tools to facilitate response
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•
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• Depicts hospital emergency management functions and how authority and responsibility is distributed
• Color coded for standardization▪ Command (white)
▪ Operations (red)
▪ Planning (blue)
▪ Logistics (yellow)
▪ Finance/Administration (green)14
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• The Incident Commander– Is the only position always activated for
every incident– Has overall responsibility to manage the
incident• Command Staff
▪Public Information Officer▪Safety Officer▪ Liaison Officer▪Medical/Technical Specialists
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• General Staff:– Organizational Component: Section– Title: Section Chief– Role: Responsible for major functional
areas of the incident– HIMT Sections
▪Operations▪Planning▪ Logistics▪ Finance/Administration
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The Incident Commander is responsible for activating the Command & General Staff positions
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• Built according to the incident– Scope and magnitude of the event– Actual or projected impact to the hospital – Hospital size and capability– Available resources (including trained
personnel)– Special response needs based on the event
cause and response needs
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• Certain management functions must be performed– Evaluate the incident/problem – Develop plan to address the problems– Assign necessary resources– Evaluate outcomes and effectiveness
• Management by objectives is essential for successful Incident Action Planning, response and recovery
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• Starts with the Incident Commander – Daytime vs. nighttime/weekends/holidays
• Section Chiefs appoint necessary positions• HIMT position titles are standardized
– Describes position’s role and mission– Position filled by the most qualified, not by
seniority– Facilitates requests for outside qualified
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• Reflects a reasonable Span of Control– Ratio of 3-7 reporting elements per 1
supervisor• Does NOT exactly mirror the daily
administrative structure– This is purposeful– Reduces role and title confusion during the
response– Success requires forethought, training and
exercising
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• Determine who best to fill roles within the HIMT
• Discuss in planning • Reinforce in training and exercises• Evaluate the competency in the role• Ensure position depth
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THE INCIDENT COMMANDER
•Hospital Administrator/Administrator On-Call•Nursing Supervisor•Chief Executive Officer•Chief Operating Officer•Chief Medical Officer•Emergency Management Coordinator•Chief Nursing Officer
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THE LIAISON OFFICER
•Chief Executive Officer•Emergency Management Coordinator•Risk Management•Chief Information Officer•Community Relations Director
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OPERATIONS SECTION CHIEF
•Chief Operating Officer•Chief Medical Officer•Chief Nursing Officer•Nursing Supervisor•Emergency Management Coordinator
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• Incidents may be different but HIMT fundamentals remain the same– Positions activated and designed to meet
needs of incident– Positions filled by qualified and trained
personnel–Key concept: based on
qualifications not seniority
• The HIMT has a defined hierarchy and chain of command
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• Command functions–Maintain overall management of
the incident–Set the incident objectives and
priorities–Devise and approve strategies–Ensure mission completion
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• Mission– Organize and direct the Hospital Command
Center (HCC)– Give overall strategic direction for hospital
incident management and support activities, response and recovery
– Authorize total facility evacuation if warranted
Key Concept: The Incident Commander is responsible until authority is delegated to another person
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• Initiate HICS by activating appropriate HIMT positions and activating the Hospital Command Center (HCC)
• Determine scope and magnitude of event and potential impacts on the facility
• Initiate and approve the IAP• Liaison with CEO, Governing Board and other
organizations
Key Concept: The IC manages the incident, not the entire hospital
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The IC commands the incident but communicates to the agency executive
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• Pre-event – The Agency Executive (or Executive body) is
responsible for overseeing overall priorities and delegating authority to the IC to manage the incident
– Demonstrates authority deemed to the IC• Event
– Integrating the hospital into the response– Communicating with governing boards and
others– Approving authority and spending levels
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• External Communications– Media– Community– Utilization of available outlets for
dissemination• Internal Communications
– Staff– Patients and family
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• Conduit internally and externally for partners and stakeholders
• Ensures consistency in information flow and sharing of intelligence
• Verification and Validation
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• Ensures the safety of all responders, patients and visitors during the response and recovery
• Completes the IAP Safety Analysis – Provides clear direction– Identifies tasks and resources
• Joins the IC as the only role that can halt operations
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• Serves as an incident specific subject matter expert
• May report to any section within the HIMT• Guidance within the HICS Guidebook to
create additional MTS for specialty needs
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• Sections are led by a Chief• Section Chiefs are known as General Staff • The Incident Commander
activates/appoints positions to Section Chief level
• Section Chiefs activate/appoint positions in their Section and Branches
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• Mission– Manage & direct tactical operations– Direct tactical resources– Carry out the mission and Incident Action
Plan• Lead by Section Chief• Largest section of resources to marshal
and coordinate
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• Mission– Develop and implement strategy and tactics to
carry out the objectives established by the Incident Commander as documented in the IAP
• Duties– Appoint Section personnel as indicated by
event– Conduct Section briefings, update staff– Maintain current status of all areas in the
Section– Communicate with and advise the Incident
Commander on issues/needs44
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• Supervises– Staging Manager– Medical Care Branch Director– Infrastructure Branch Director– Security Branch Director– HazMat Branch Director– Business Continuity Branch
Director– Patient Family Assistance
Branch Director
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• Mission– Organize and manage the
deployment of supplementary resources, including personnel, vehicles, equipment, supplies, and medications
• Supervises– Personnel Staging Team– Vehicle Staging Team– Equipment/Supply Staging Team– Medication Staging Team
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• Duties:– Coordinate delivery of resources to
requesting area– Establish a staging area in a central location
▪ Area must be large enough to accommodate resources
– Work closely with the Logistics Section▪ Once resources are acquired by Logistics, they
are then staged with the Staging Manager– If staging area resources become too great,
appoint appropriate Team Leaders
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• Mission– Organize and manage the delivery of
emergency, inpatient, outpatient, casualty care, and clinical support services
• Duties– Address provision of acute and
continuous care – Work closely with Logistics Section to
ensure resource acquisition – Work closely with Staging Manager for
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• Supervises– Inpatient Unit Leader (all inpatient units)– Outpatient Unit Leader (all outpatient
services)– Casualty Care Unit Leader (Emergency
Department)– Behavioral Health Unit Leader – Clinical Support Unit Leader (Lab, Diagnostic
Imaging, Pharmacy, Morgue, Blood Donor)
– Patient Registration Unit Leader
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• Mission– Organize and manage the services required
to sustain and repair the hospital’s infrastructure operations
• Duties– Maintain overall facility operations and
normal operating capacity– Identify and fix utility service-delivery
failures▪ Coordinate the acquisition of parts or contractors
with the Logistics Section– Address facility damage as needed
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• Supervises– Power/Lighting Unit Leader– Water/Sewer Unit Leader– Heating Ventilation Air Conditioning (HVAC)
Unit Leader– Building/Grounds Unit Leader– Medical Gases Unit Leader
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• Mission– Organize and direct hazardous material
incident response activities▪ Detection and monitoring▪ Spill response▪ Victim, technical, and emergency decontamination▪ Facility and equipment decontamination
• Duties– Oversee the operations of a hazmat event
▪ Decontamination of victims, staff, facility▪ Safe and appropriate use of Personal Protective Equipment
(PPE)▪ Supervise clean up operations
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• Supervises– Detection and Monitoring Unit Leader– Spill Response Team Unit Leader– Victim Decontamination Unit Leader– Facility/Equipment Decontamination Unit
Leader
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• Mission– Coordinate activities related to internal and
external security• Duties
– Implement security measures – Ensure security and access control for
Hospital Command Center– Liaison with law enforcement personnel– Oversee search and rescue operations
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• Supervises– Access Control Unit Leader– Crowd Control Unit Leader– Traffic Control Unit Leader– Search Unit Leader– Law Enforcement Interface Unit Leader
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• Mission– Ensure business functions are maintained,
restored or augmented to minimize financial impact
– Ensure business interruption insurance activities are implemented
• Duties– Facilitate access to essential recovery
resources, including business records– Support relocation to alternate business sites
including coordination of IT services with Logistics Section
– Assist with restoration of normal operations56
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• Supervises– IT Systems and Applications Unit Leader
▪ Ensure IT business functions are maintained, restored or augmented
▪ Works closely with Logistics Section IT Information Services and Equipment Unit Leader
– Service Continuity Unit Leader▪ Ensure business/clinical/ancillary service functions are
maintained, restored or augmented– Records Management Unit Leader
▪ Ensure vital business/medical records are maintained and preserved
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• Mission – Organize and manage patient family care
needs, including communication, lodging, food, healthcare, and spiritual and emotional needs
• Duties– Provide family assistance resources– Facilitate family reunification– Communicate with outside agencies
• Supervises– Social Services Unit Leader– Family Reunification Unit Leader
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positions are activated as needed by the incident response
• Branches are activated and staffed based on response needs
• The is responsible to– Manage & direct tactical operations– Direct tactical resources– Carry out the mission and Incident Action
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• Mission– Collect, evaluate, and disseminate incident
action information and intelligence to Incident Commander
– Prepare status report and display information
– Archive all critical information and generated paperwork
– Coordinate development of Incident Action Plan (IAP)
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• Mission– Oversee all incident-related data gathering
and analysis regarding incident operations and assigned resources
– Develop alternatives for tactical operations– Conduct planning meetings
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• Mission– Prepare Incident Action Plan (IAP) for each
operational period and disseminate to Hospital Command Center staff
– Ensure distribution of critical information to appropriate Hospital Incident Management Team personnel
– Assist in the development of the Corrective Action Plan
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• Duties– Ensure distribution of critical information/data– Compile scenario projections from all Section
Chiefs and oversee long range planning– Document and distribute facility Incident Action
Plan– Maintain current status of all Sections– Ensure documentation being done by HIMT
positions is completed, collected and archived
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• Supervises– Resources Unit Leader– Situation Unit Leader– Documentation Unit
Leader– Demobilization Unit
Leader
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• Mission– Maintain information on status, location,
and availability of personnel, teams, facilities, supplies, and major equipment to ensure availability of use during incident
– Maintain a master list of all resources assigned to incident operations
• Oversees– Personnel Tracking Manager – Materiel Tracking Manager
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• Personnel Tracking Manager– Mission
▪ Maintain information on status, location, and availability of on-duty staff and volunteer personnel
• Materiel Tracking Manager– Mission
▪ Maintain information on status, location, and availability of equipment and supplies within hospital inventory and additional materiel received from outside agencies in support of incident
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• Mission– Collect, process, and organize situation information– Prepare situation summaries– Develop projections and forecasts of future events
related to the incident– Gather and disseminate information and intelligence
for use in the Incident Action Plan (IAP)
• Focus is current and future situation management
• Write and maintain situation updates and IAPs
• Maintain Hospital Command Center status boards69
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• The Situation Unit is very busy– Provide sufficient clerical assistance– Assign personnel to monitor TV, radio and
social media – Collaborate with Liaison Officer
• Supervises– Patient Tracking Manager– Bed Tracking Manager
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• Patient Tracking Manager– Mission
▪ Monitor and document location of patients at all times within hospital's patient care system
▪ Track destination of all patients departing the facility
• Bed Tracking Manager– Mission
▪ Maintain information on status, location, and availability of all patient beds, including disaster cots and stretchers
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• Mission– Maintain accurate and complete Hospital
Command Center incident files – Provide duplication services to incident
personnel– File, maintain, and store incident files for legal,
analytical, and historical purposes
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• Duties– Collect, organize and archive all response and
recovery documentation and paperwork (forms)– Assist in writing Incident Action Plan (IAP) – Assist in preparing After-Action Report and
Corrective Action Plan based on lessons learned– Collaborate with Situation Unit Leader
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• Mission– Develop and coordinate an Incident Demobilization
Plan, including specific instructions for all staff and resources requiring demobilization
• Duties– Draft demobilization and system/business recovery
plan for incident, as approved by Incident Commander
– Address planning for recovery EARLY in response– Initiate HICS 221 – Demobilization Checklist
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• The is responsible for– Collecting, evaluating and disseminating
incident situation information and intelligence to Hospital Command Center
– Maintaining resource status– Maintaining status boards– Developing Incident Action Plan (IAP)
Key Concept: Verification and Validation75
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• The is responsible for– Archiving all response and recovery
documentation– Assisting with development of After-Action
Report and Corrective Action Plan– Assisting with financial recovery and
reimbursement
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• Provides service and support to other sections
• Acquires resources from internal and external sources – Activate existing Memorandum(s) of
Understanding (MOUs), contracts and vendor agreements
– With Finance Section, employs standard and emergency procurement and contracting procedures
• With Liaison Officer, links to local Emergency Operations Center (EOC) and/or Regional Hospital Coordination Center (RHCC) for resource requests
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and are closely linked and must work collaboratively together
is the “getter” is the “doer”
• Scope and Responsibilities overlap and coordinate– Logistics Supply Unit and Operations
Infrastructure Branch– Labor Pool & Credentialing Unit Leader and
Staging Manager (Personnel Staging Team Leader)
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• Mission – Organize and direct operations associated
with maintenance of physical environment and provision of human resources, materials, and services to support incident activities
– Participate in incident action planning
• Duties– Oversee acquisition of resources– Maintain current status of section
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• Supervises– Service Branch Director
• Communications Unit Leader• IT Information Services and Equipment Unit Leader• Food Services Unit Leader
– Support Branch Director• Employee Health and Well-Being Unit Leader• Supply Unit Leader• Employee Family Care Unit Leader• Transportation Unit Leader• Labor Pool and Credentialing Unit Leader
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• Mission– Organize and manage services required to
maintain hospital’s communication system, food and water supply, and information services equipment
• Oversees– Communications Unit Leader– IT Information Services and Equipment Unit
Leader– Food Services Unit Leader
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• Communications Unit Mission: Organize and coordinate internal and external communications connectivity
• IT Information Services and Equipment Unit Leader– Mission: Provide computer hardware, software and
infrastructure support to staff• Food Services Unit Leader
– Mission: Manage food and water stores for patients, family, visitors and staff
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• Mission– Organize and manage services required to maintain
hospital’s supplies, transportation, and labor pool. – Ensure provision of logistical, psychological, and
medical support of hospital staff and their dependents.
• Oversees– Employee Health and Well-Being Unit Leader– Supply Unit Leader– Employee Family Care Unit Leader– Transportation Unit Leader– Labor Pool and Credentialing Unit Leader
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Employee Health and Well Being Unit- Mission
▪ Provide medical screening, evaluation and follow-up of staff who are assigned to the incident
▪ Ensure availability of medical care for injured or ill staff
▪ Ensure availability of behavioral and psychological support services to meet staff needs during and following an incident
▪ Coordinate mass prophylaxis/ vaccination/ immunization of staff, if required
▪ Coordinate medical surveillance program for employees
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• Employee Family Care Unit– Mission
▪ Ensure availability of medical, logistic and behavioral health and day care for the families of staff members.
▪ Coordinate family prophylaxis/vaccination/immunization.
• Transportation Unit– Mission
▪ Organize and coordinate transportation of all ambulatory and non-ambulatory patients.
▪ Arrange for the transportation of human and materiel resources within or outside the facility
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• Labor Pool and Credentialing Unit– Mission
▪ Collect and inventory available staff and volunteers at a central point (Labor Pool) for assignment by Staging Officer.
▪ Maintain adequate numbers of both medical and non-medical personnel
▪ Collaborate with Operations Section Staging Manager
• Supply Unit– Mission
▪ Acquire, inventory, maintain, and provide medical and non-medical care equipment, supplies, and pharmaceuticals
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• The oversees and obtains the resource requirements of the response
has two branches– Support– Service
works closely with the
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• Mission– Account for costs and losses incurred from
the outset of response – Account for expenses from multiple cost
centers – Monitor, track and report personnel, time,
repair, purchase, and replacement expenses and lost revenue
– Modify or expand daily (usual) accounting practices to meet needs of the incident and outlined in Emergency Operations Plan
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• Mission– Monitor utilization of financial assets and
accounting for financial expenditures.– Supervise documentation of expenditures
and cost reimbursement activities
• Duties– Oversee acquisition of supplies and services
to carry out medical mission– Supervise documentation of expenditures
relevant to emergency incident– Directs financial RECOVERY
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• Supervises– Time Unit Leader– Procurement Unit Leader– Compensation/Claims
Unit Leader– Cost Unit Leader
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• Mission– Responsible for documentation of personnel
time records. – Monitor and report on regular and overtime
hours worked/volunteered
• Duties– Adjusts reports and tracking to meet incident
needs• Tracking of altered or expanded work
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• Mission– Administers accounts receivable and
payable to contract and non-contract vendors
• Duties – Initiates emergency contracts
▪ Agreements should be already in place ▪ Confirm existing vendors can deliver in
emergencies ▪ Confirm payment arrangements
– Manages purchase orders96
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• Mission– Responsible for receiving, investigating and
documenting all claims reported to hospital during emergency incident, which are alleged to be the result of an accident or action on hospital property
• Duties– Manages claims and worker’s compensation
issues ▪ Injury/illness to staff, volunteers and visitors▪ Follow up coverage/compensation/benefits clearly
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• Mission– Responsible for providing cost analysis data for
declared emergency incident and maintenance of accurate records of incident cost
• Duties– Track and pay response and recovery costs – Projects lost revenue– Prepares documents for state/federal
reimbursement when applicable– Tracks payments
▪ Patient insurance and reimbursement▪ Government
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• The – Projects and manages costs related to the
incident– Provides
▪ Accounting▪ Procurement▪ Time recording▪ Cost analysis
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Incident Commander
Operations Section Chief
Resident Services
Nursing
Psychosocial
Admit/Transfer & Discharge
Infrastructure
Dietary
Environmental
Physical Plant/Security
PlanningSection Chief
Situation
Documentation
LogisticsSection Chief
Service
Communication Hardware
IT/IS
Support
Supply
Staffing/Scheduling
Transportation
Finance/Admin
Section Chief
Staff Time
Procurement/Costs/Claims
Medical Director/Speci
alist
Safety Officer
Liaison Officer
Public Information
Officer
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Keys to Effective Response and Recovery
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• Planning is essential in all phases of emergency management– Mitigation (including prevention)– Preparedness
▪ Developing Emergency Plans and response specific plans
▪ Training and Exercising– Response – Recovery
▪ Business Continuity ▪ Return to normal operations
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• Provides organization’s strategic direction• Maximizes available resources• Reduces omissions and duplication of
efforts• Reduces cost• Gathers and disseminates information• Improves and enhances communication• Provides historical record of incident• Assists with review and corrective
improvement105
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• What is incident action planning?– Ordered sequence of steps created to
achieve incident objective(s) within specific timeframe
– Direction to accomplish incident objectives as set by Incident Commander based upon priorities
– Assignment of strategies, tactics and resources to accomplish the response objectives
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• Incident Action Plans may be shared with or requested by the Local Emergency Operation Center (EOC)/ Regional Hospital Coordinating Center (RHCC) or other responders– Beneficial (if not critical) to set common
goals with external partners– Provides framework of hospital status,
needs, and capabilities
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• Management by Objectives IS Incident Action Planning
• Incident action planning requires thorough understanding of organizational policy and direction– Established in Emergency Operations Plan
(EOP) and supporting plans– As set by Agency Executive / Governing
Body
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Incident Action Plan must be developed by personnel who understand– Mission of hospital during emergency
response and recovery – Limitations of hospital, for example:
• Lack of ability to decontaminate large numbers• No burn care facilities or specialists
– Hospital’s overarching policies on response and recovery
– All-hazards Emergency Operations Plan 109
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Management by Objectives Process– Assess and understand incident situation– Determine overall priorities– Set Operational Period– Establish specific, measurable, attainable
objectives
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Management by Objectives Process– Select effective strategies and tactics to accomplish
objectives– Identify needed resources– Develop and issue assignments– Direct, monitor, and evaluate response efforts to
enhance response for next operational period– Initiate corrective actions
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Incident Action
Planning
Process:
The Planning P
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• HICS leadership must understand situation (cause, effects, response options)
• Gather and analyze information– Hazard/incident type– Impact of hazard/incident on hospital– Expected duration of incident
• Situation must be reassessed regularly throughout response and recovery process
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• Incident Commander conducts initial incident assessment– Type of incident, location, magnitude, possible duration– On-going hazards and safety concerns– Determine initial priorities based on:
#1– Life saving#2– Incident stabilization#3– Property preservation
– Activate Hospital Command Center (HCC)• Level of activation
– Set initial operational period114
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• Estimated period of time scheduled for execution of given set of tactical actions in Incident Action Plan (IAP)
• Set by Incident Commander, based on incident
• Usually set in hours– Does not have to conform to shift times– Can be long or short, depending on intensity
and magnitude of incident– May be adjusted as situation unfolds
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• Incident Objectives– Broad organizational objectives are foundational and
do not change during response and recovery– Equate to where hospital wants to be at end of
response– Not limited to specific operational period
• Examples– Ensure adequate care to all victims of incident– Provide for safety of hospital personnel
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• Strategies– General direction selected to accomplish
incident objective (e.g., re-establish power to clinic)
– Approach to achieving incident objectives
• Tactics– Specific actions, sequence of actions,
procedures, tasks, assignments to meet strategies and objectives (e.g., activate backup generators)
– “Boots on the ground” or “doers”
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• Event– Severe storms with sustained high winds
have damaged multiple buildings in the area, including hospitals, clinics, public safety and long term care facilities
• Healthcare Facility Objective– Ensure the continuation of care to patients
and prepare for an influx of injured or displaced persons
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Section Incident Strategy Tactics
Operations
• Activate alternate care sites for evacuated patients and incoming casualties
• Assess facility for damage and initiate repairs
• Assess infrastructure of hospital and status of critical services
• Activate damage teams to assess impact on patient care areas and designated alternate care sites
• Activate internal damage assessment plan for all offices and non-clinical areas to determine use for patient care
• Activate units under Infrastructure Branch to assess critical services
Planning
• Develop Incident Action Plan in collaboration with IncidentCommander
• Gather situational information from community partners
• Notify all sections to provide names of persons in HIMT positions
Logistics
• Inventory and assess for damage, all supplies, equipment, food and water resources
• Provide needed protective or safety gear to employees as directed
• Notify department heads to inventory all designated emergency supplies and equipment and report damages and shortages
• Access caches of safety supplies and ensure delivery to identified employees
Finance
• Develop cost and reimbursement tracking mechanism(s)
• Manage payment and reimbursement activities
• Complete cost /reimbursement tracking templates
• Submit payment and reimbursement documentation to appropriate parties
• Evaluate recorded costs/reimbursements
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• Resources necessary to meet objectives • Resources may include:
– Personnel– Equipment– Supplies– Personal Protective Gear– Pharmaceuticals– Vehicles
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• Once objectives and essential resources are identified, assignments are issued:– Hospital Incident Management Team (HIMT)
positions and response roles activated according to incident needs
– Staff assigned to conduct incident specific operations, such as:▪ Evacuation▪ Decontamination▪ Triage and treatment▪ Safety measures
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• Direct, monitor, and assess response efforts – Constant monitoring of strategies and tactics
for effectiveness– Assess incident objectives
▪ Are objectives being achieved?▪ Are strategies/tactics safe?▪ Are strategies/tactics effective?
• Evaluation is ongoing process throughout response and recovery
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Throughout response incident objectives, strategies, and tactics should be kept current and relevant
Action Plan Revision
Initiate Modifications
for Next Operational
Period
Evaluation
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• Conduct current situation assessment▪Update situation/incident information▪Assess impact on the hospital▪Length and duration of
continued/resolving incident▪Resource availability
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• Assess incident objectives• Ensure objectives are achieved in a safe
and timely manner (e.g., assign and follow-up)
• Revise objectives, strategies, tactics, and resource needs for upcoming operational period
• Modify plan, including planning for demobilization
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• Formal documentation of IAP– Provides common set of objectives for HIMY
personnel– Enhances communication between HIMT
personnel– Provides tool for evaluation of objectives and
response effectiveness
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• Formal documentation of IAP– Provides written archive of actions for
▪ After Action Report and Corrective Action Plan
▪ Reimbursement for response and recovery▪ Revision or development of standard
operating plans
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Key concept
– Written Incident Action Plan (IAP) is essential for guidance and documentation
• Note: for Federal reimbursement considerations: “If it wasn’t documented….it didn’t happen”…..and hospital may not be reimbursed by State or federal programs.
• Written IAP required for HazMat events
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Each Command and General Staff position has distinct roles and responsibilities for developing IAP– Incident Commander– Safety Officer– Planning Section Chief– Operations Section Chief– Logistics Section Chief– Finance/Administration Section Chief
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• Incident Commander will– Determine incident objectives and priorities– Set operational period– Activate HIMT positions as needed– Establish policy for resource orders– Approve initial actions and completed IAP
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• If event affects only the hospital, the Hospital Incident Commander names event
• If event is external and impacts jurisdiction or multiple agencies– Local emergency management or on-scene
Incident Commander names event
Key Concept: Get the name and include on your paperwork!!
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• Safety Officer– Advises Incident Commander and Section Chiefs on
safety issues and protective measures– Develops HICS 215 A: Incident Action Plan Safety
Analysis• Identifies hazards• Determines mitigation strategies• Delineates safe practices• Oversees safety of operations and tactics• Assigns responsibility
NOTE: Safety Officer has authority to stop any actions immediately dangerous to life and health, but needs to report promptly to Incident Commander
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• Planning Section Chief– Prepares for Planning Meetings
▪ Gather information for Incident Action Plan– Conducts Planning Meeting– Coordinates preparation of IAP– Submits final IAP to Incident Commander for
approval– Disseminates IAP to all Hospital Command Center
personnel– Develops demobilization and contingency plans
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• Operations Section Chief– Determines/assesses operational areas– Advises Incident Commander of activated
positions in Operations Section, as dictated by incident
– Determines tactics– Determines work assignments– Determines resource requirements– Provides resource projections to Planning
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• Logistics Section Chief– Ensures resource ordering procedures are
developed to meet needs– Advises Incident Commander on positions
activated in Logistics Section– Ensures the IAP can be supported with
resources– Develops IAP supporting plans
▪ Communications Plan▪ Transportation Plan
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• Finance/Administration Section Chief– Provide cost implications of incident
objectives– Ensure IAP is within cost limitations
established by management– Advise Incident Commander on activated
positions within Finance/Administration Section, as needed by incident
– Ensure applicable forms are completed and submitted
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• Based on FEMA ICS forms• Customized for healthcare use• Captures the Incident Action Plan
– Guides the response– Manages resources– Ensures accountability– Aids recovery & reimbursement– Guides corrective improvement
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• Details about the actual incident as they are collected (e.g., fire, plane crash, widespread illness): HICS 201: Incident Briefing
• Organization and branch assignments: HICS 203: Organization Assignment List, HICS 204: Assignment List
• Critical problems encountered and incident command actions taken: HICS 202: Incident Objectives, HICS 213: General Message Form, HICS 214: Activity Log
• Safety problems encountered and/or addressed: HICS 215A: Incident Action Plan [IAP] Safety Analysis
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• Patient location: HICS 254: Disaster Victim/Patient Tracking
• Casualty/fatality information: HICS 254: Disaster Victim/Patient Tracking, HICS 259: Hospital Casualty/Fatality Report
• Resources on hand and requests for supplementation: HICS 256: Procurement Summary Report, HICS 257: Resource Accounting Record
• Resource directory: HICS 258: Hospital Resource Directory
• Facility status: HICS 251: Facility System Status Report
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• Demobilization/System Recovery is the phase that transitions management operations and support functions and elements from incident activities back to normal operations as operational objectives are attained.
• Utilize HICS 221 Demobilization Check Out
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HICS 221 Demobilization Check Out
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• Demobilization is part of incident action planning process and documented in Incident Action Plan
• May be obvious:– Incident ends
• May be more complicated: – Incident continues for a prolonged time, but
continued activation of some resources are no longer needed
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• Structured process of deactivating roles & positions
• May require additional positions be activated
• Focus shifts from response to recovery▪ Address backlogs of procedures, clinic
visits, and other important patient care tasks that were deferred during response
▪ Return to normal activities and to readiness• Command and Planning Section are last
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• Hospital reputation can be damaged by an incident
• Demobilization may be perceived unfavorably by the public
• Consider announcement of demobilization in conjunction with other affected response partners
• Emphasize that the hospital is recovering and is returning to its normal business operations
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1. Assess affected services or departments for ability to resume normal operations using Demobilization Checklist (HICS 221)
2. Assess equipment and restocking needs– Ensure equipment and supply readiness– Release outside resources no longer needed
3. Continue financial restoration– Assure incident response and recovery costs are
reported• Include losses such as cancellation of surgeries,
procedures and other missed opportunities for patient care
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4. Announce demobilization– Notify staff– Notify relevant entities
▪ Jurisdictional authorities▪ Response partners and personnel▪ Agency or corporate leadership▪ Internal hospital personnel, patients, and families▪ The public
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• Staff relief and return to normal schedules• Staff debriefing and critical incident stress
management▪ Mourning for line-of-duty deaths
• Medical care follow-up when indicated• Family support as needed• Expressions of appreciation and recognition
of staff
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• Recovery follows response and focuses on returning hospital to baseline level of functioning, return to normal, or “new” normal operations
• Successful recovery can significantly improve hospital function– Hazard/risk reduction or elimination through
mitigation– Enhanced operational procedures– A base for long-term growth established– Improvements with reconstruction
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• Recovery starts– As soon as response structure is activated,
through documentation and ongoing problem solving
• Transition from response to recovery is not always obvious
• Recovery principles are outlined in hospital Emergency Operations Plan
• Recovery may extend over a long time, from weeks to years
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• Private insurance• Grants / donations• Federal reimbursement
– A Quick Guide: FEMA Reimbursement for Acute Care Hospitals
• What is covered• What is not covered• Assistance with post-event structural
improvements
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• Incident Action Plan provides all Hospital Incident Management Team (HIMT) personnel direction for actions based on objectives set for operational period
• Incident action planning uses elements of Management by Objectives
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• Incident action planning is conducted by Command and General Staff
• Incident action planning is essential for effective response and recovery
• Demobilization and system recovery are part of incident action planning and need to be addressed early in response
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• An incident management tool to familiarize user with critical aspects of HIMT positions
• The series of action steps intended to prompt HIMT members to take related to their specific roles and responsibilities
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• HICS provides 79 Job Action Sheets (JAS)
• Positions are activated based on– Scope and magnitude of the event– Projected impact of the event– Hospital size– Available resources– Response needs
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Job Action Sheets are standardized to includeTitle – the name of the positionMission – a brief statement summarizing the
basic purpose of the jobFundamental Information Box –
▪ Date and times▪ Reporting relationships▪ Records to whom the position is assigned▪ Location of Hospital Command Center ▪ Contact information and radio title
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Job Action Sheets provide Action Steps and Considerations listed by response periods:
– Immediate 0–2 hours– Intermediate 2–12 hours– Extended Beyond 12 hours– Demobilization and System Recovery
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• Format enables users to– Document each action undertaken with initials– Record decision and action timeframes
• Many action steps are common to all positions– Read entire Job Action Sheet– Put on position identification– Notify your usual supervisor of your HICS position– Document using forms– Coordinate with other HICS positions– Include considerations for shift change report
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Documents/Tools
• Incident Action Plan• HICS Form 204 – Branch Assignment Sheet• HICS Form 207 – Organization Chart (Incident Management
Team Chart)• HICS Form 213 – Incident Message Form• HICS Form 214 – Operational Log• HICS Form 257 – Resource Accounting Record• Hospital emergency operations plan• Hospital organization chart• Hospital telephone directory• Radio/satellite phone
Customize this section
to your facility!
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• No Job Action Sheets written for a Deputy Chief or Assistants– They work from Job Action Sheet of position they
assist• Deputy Chief
– Assigned for Command or General Staff– Have decision-making power as delegated by
Command/Section Chief• Assistant
– Assigned for Command or General Staff– Assigned to Unit Leaders as needed and resources
allow– No delegated decision-making power, solely to
assist Command/Section Chief/Unit Leader163
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• Use the Job Action Sheets – To preliminarily document actions taken during
incident – To develop a chronology of events, problems
encountered, and decisions made
• Use the Activity Log: HICS Form 214 continuously to detail actions, decisions and activities
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• Job Action Sheets are used continuously during the response– Actions in all operational periods should be
continued and monitored
• Job Action Sheets should transfer to your replacement and actions continued– Upon shift change or position change
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• The Job Action Sheets are designed to be customized for the needs of each hospital– Hospitals can use Job Action Sheets as
prepared, or– Modify Job Action Sheets based on
▪ Hospital size▪ Available resources▪ Response needs▪ Unique facility considerations or responsibilities
– Hospitals can develop unique Job Action Sheets166
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• Hospitals are encouraged to use HICS Job Action Sheet model as a template for customization– Maintain prescribed format and terminology
to ensure standardization benefit of National Incident Management System
– Modify Response Period Actions and Documents and Tools section appropriately for facility and community
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• Job Action Sheets designed so they can be abbreviated (interventions below headings can be pulled out) to make a pocket guide
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• Review all HICS Job Action Sheets – Convene subject matter experts and
stakeholders (internal and external) to review Job Action Sheets
– Engage staff who would fill those roles – Use in exercises to test application
• Review Job Action Sheet use post exercise– Revise content as necessary with details (e.g.
correct telephone numbers, etc.)– Place own hospital logo on each Job Action
Sheet169
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• Job Action Sheets should be used in trainings and exercises– Enhance familiarity of position description,
mission and actions• Conduct focused drills with Branches
and Sections to enhance understanding of the Hospital Incident Management Team structure
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• The Job Action Sheets are– An incident management tool– A series of actions to meet incident response– Divided in response periods
▪ Immediate 0-2 hours▪ Intermediate – 2-12 hours▪ Extended – Greater than 12 hours▪ Demobilization/System Recovery
– Standardized to facilitate interagency response– Key concept: Customize for the unique
facility needs and roles
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HICS Tools:
HICS Forms
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• Purpose– To provide Hospital Incident Management Team
with documents needed to manage an incident• Use
– Each form has a specific purpose identified at bottom of the form
– Instruction sheets for each form can be printed on reverse side of each form, if desired
• Forms have been modified from updated FEMA ICS forms for use in hospitals
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• Format includes– Form name and number– Who completes– When form is completed
• 23 HICS forms (including the IAP Cover Sheet and IAP Quick Start)– Found in Guidebook Appendix H
• Use HICS forms with facility forms• Develop additional forms as needed
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• HICS forms completed by HIMT– Forms can be done electronically or hand-
written– Write legibly and clearly– Complete all areas on form
• Completed forms distributed with a copy to Planning Section– Forms will be archived to document response
• Forms and other incident documentation used to craft the After Action Report
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No. Name Responsible
200 Incident Action Plan Cover Sheet Planning Section
201 Incident Briefing Incident Commander
202 Incident Objectives Planning Section
203 Organizational Assignment List Planning Section/Resource Unit Leader
204 Assignment List Section Chiefs/Branch Directors
205A Communications Log Communications Unit Leader
206 Staff Medical Plan Support Branch Director
207 HIMT Chart Planning Section
213 General Message Form All Positions
214 Activity Log All Positions
215A Incident Action Plan Safety Analysis
Safety Officer
221 Demobilization Check-out Planning Section/ Demob Unit Leader
251 Facility System Status Report Infrastructure Branch Director
HICS Forms
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No Name Responsible
252 Section Personnel Time Sheet Section Chiefs
253 Volunteer Registration Labor Pool & Credentialing Unit Leader
254 Disaster Victim / Pt Tracking Patient Tracking Manager
255 Master Pt Evacuation Tracking Form Patient Tracking Manager
256 Procurement Summary Report Procurement Unit Leader
257 Resource Accounting Record Section Chiefs
258 Hospital Resource Directory Resource Unit Leader
259 Hospital Casualty / Fatality Report Patient Tracking Manager
260 Patient Evacuation Tracking Form Inpt Unit Leader Outpt Unit Leader, Casualty Care Unit Leader
IAP Quick Start Incident Commander / Planning Section Chief
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• Purpose
– Summarizes basic information regarding incident situation and resources allotted
• Origination
– Incident Commander• Copies to
– Command staff, Section Chiefs, and Documentation Unit Leader
• When to Complete
– Prior to briefing the next operational period• Helpful Tips
– Distribute to all staff before initial briefing181
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• Purpose
– Defines the Incident Objectives• Origination
– Incident Commander and Planning Section Chief
• Copies to
– Command staff, General Staff and Documentation Unit Leader
• When to Complete
– Prior to briefing the current operational period• Helpful Tips
– Serves as a roadmap to incident management186
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• Purpose: – Document Hospital Incident Management Team
staffing• Origination:
– Planning Section/Resources Unit Leader• Copies to:
– Command Staff and General Staff– Branch Directors and Agency Staff– Documentation Unit Leader
• When to complete– At the start of the first operational period– Prior to each subsequent operational period– As additional positions are staffed
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• Agency Representative (assigned to HCC)▪ Use proper name to identify personnel
representing external agency, and include agency name.
• Hospital Representative (assigned to external EOC)
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• Purpose: – Document assignments within a Section or Branch
• Origination: – Section Chief or Branch Director
• Copies to:
– Command and General Staff– Documentation Unit Leader
• Prepared by: – Section Chief/Branch Director
• Approved by: – Planning Section Chief
• When to complete: – At the start of each operational period
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• Define the incident objectives in relation to the Section/Branch
• What are the strategies/tactics to accomplish that objection
• What resources are needed• What Unit is it assigned to• Define the activated Units and
assignments
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• Purpose:
– Provide standardized method or recording messages received by phone, radio or verbally
• Origination:
– All positions
• Original to:
– Receiver
• Copies to:
– Message taker– Documentation Unit Leader
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• Use:– Reply requested: Indicate whether a reply was
requested and to whom reply should be addressed, if different from Sender
– Priority: Indicate level of urgency of the message– Message:
▪ KEEP ALL MESSAGES/REQUESTS BRIEF, TO THE POINT, AND VERY SPECIFIC
▪ Transcribe complete, concise, and specific content of message.
– Action Taken, if any: ▪ Note any action taken in response to message▪ When message is routed to any additional recipient,
indicate who received, time received, action taken or other comments, and next person to whom message was forwarded
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• Purpose: Document– Incident issues encountered– Decisions made– Notifications conveyed
• Origination: – Hospital Incident Management Team positions
• Copies to: – Incident Commander– Planning Section Chief– Documentation Unit Leader
• When to complete: – Continuously as a tool used to record major decisions (and
critical details as needed) at all levels– From activation through demobilization
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• Purpose:
– Document hazards and define mitigation
• Origination:
– Safety Officer
• Copies to:
– Command Staff, General Staff, Sections and Branches
• When to complete:
– Prior to safety briefing
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• Purpose:
– Ensure all resources and supplies used in response and recovery are returned to pre-incident status
• Origination:
– HIMT personnel as directed by Incident Commander or Section Chief
• Copies to:
– Command Staff, Section Chiefs, and Documentation Unit Leader
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• Purpose: – List resources to contact
• Origination: – Resources Unit Leader
• Copies to: – Command and General Staff
• Instructions:– Record complete contact information for agencies, service
providers, vendors, etc., that provide critical resources
• When to complete: – Whenever possible prior to an event– At the start of each operational period, and as changes are
made 205
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• There is no specific Incident Action Plan form
• The IAP minimally consists of– HICS 201: Incident Briefing– HICS 202: Incident Objectives– HICS 203: Organizational Assignment List– HICS 204: Branch Assignment List– HICS 215A: Incident Action Plan Safety
Analysis206
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• Designed to be a shorter form to fill out instead of full core forms
• Can be used for small incidents• Or when you have to rapidly start
documentation and then expand to full forms as resources are available and incident expands.
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• HICS Forms are now available in Word format– www.hicscenter.org
• Use of forms– Hard copy; legibility is important– Loaded onto intranet of facility or IS
management system– Loaded on Hospital Command Center
computers– Projected in the Hospital Command Center
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• The HICS forms– Provide HIMT with response management
documents – Assist in communication with external
agencies and resources – Assist in communication with hospital staff – Provide documentation for response and
recovery activities
Key concept: Use in trainings and exercises
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• During the initial response period, activities are guided by– Emergency Operations Plan– Hazard Vulnerability Analysis– Hazard specific response guides
• These plans/guides assist the IC– To conduct a situation assessment– Set initial objectives– Establish the HCC/ICS organization
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• An incident specific scenario sets the stage for the Incident Planning Guides and Incident Response Guides
• 16 scenarios help each facility plan for and respond to incidents in their facility
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• Active Shooter • Chemical Incident • Hostage/Barricade • Earthquake • Shelter-in-
Place/Evacuation/Healthcare Facility Abandonment
• Explosive Incident • Infectious Disease • Information Technology
• Mass Casualty Incident • Missing Person • Radiation Incident • Severe Weather with
Warning • Staff Shortage • Tornado • Utility Failure • Wildland Fire
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• Hospitals can use these incident-specific guides– According to the facility and community
Hazard Vulnerability Analysis
• Additional Incident Planning Guides and Incident Response Guides may need to be developed by the facility to address a hazard or threat not already developed
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• Outline strategic planning considerations• Can be used to evaluate the facility’s
hazard specific plans• Used to develop customized Incident
Response Guides• Formatted to the emergency
management phases• Mitigation• Preparedness• Response• Recovery
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• Are hazard specific• Are activated during response and
recovery• Provide critical considerations and actions
for the Command and General Staff• Are based on response periods:
▪ Immediate : 0-2 hours▪ Intermediate : 2-12 hours▪ Extended : Greater than 12 hours▪ Demobilization/System Recovery
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• Should complement current plans and guides– Emergency Operations Plan
▪ They complement the EOP but not replace the EOP
– Job Action Sheets
• Can be used for initial documentation• Critical tool for administration
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• Uses of Guides– To evaluate Emergency Operations Plan and
Hazard Specific Plans– As a training tool– As a scenario for tabletop exercises– As a planning basis for a functional exercise
• Guides will promote more immediate and higher quality decision making
• Guides will allow leadership to focus efforts for specific hazard
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Command Objectives that can be used in
Incident Action Planning
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Another opportunity for customization to your
facility
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• The Incident Response Guides are not intended to be a replacement for Job Action Sheets– Job Action Sheets
▪ Detail position actions, decisions and activities▪ Are all-hazards focused
– Incident Response Guides ▪ Tool for Command▪ Provides overview of position actions and decision
making▪ Are Incident Specific
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• Incident Planning Guides and Incident Response Guides– Are incident-specific tools to assist with
planning, training and response/recovery efforts– Designed to assist in meeting documentation
requirements– Guide Command and General Staff with
decision-making and action-taking– Should be consistent with Emergency
Operations Plan– Do not replace the Job Action Sheets
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• Building relationships• Emergency preparedness requires
integration/collaboration with community responders and coalitions
• Include city, county, regional, state, and federal agencies
• The Joint Commission requires community-wide planning and collaboration.
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Local Community Planning:
• Public Safety– Law Enforcement– Fire– EMS
• Public Health• Medical Examiner or Coroner• Emergency Management (local agency)• Behavioral/Mental Health• Other public and private agencies
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• All Disasters are Local• Meeting with external partners to
– Understand community response roles and limitations
– Develop regional response plans and procedures– Plan, conduct, and evaluate collaborative exercises– Conduct multi-disciplinary training– Build collaborative relationships across disciplines– Share strengths and gaps
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• External Healthcare Agencies– Other healthcare agencies– Healthcare Coalitions– Hospital Associations
• Within the corporate healthcare system• Non-hospital facilities
– Clinics– Urgent Care Centers and physician offices– Long-term care facilities
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• Best Practices– Cooperative planning, training, and joint
exercises– Standardization of Terminology
• Use of HICS• Mutual aid and resource sharing• Integrated plans and procedures
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Mutual Aid Agreements or Memorandum of Understanding/Agreement
– Request assistance from external agencies – Share emergency resources
▪ Hospital and/or Community resources– Disaster credentialing of staff/volunteers– Facilitate patient transfers– Standardize purchases of equipment and
supplies
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• Public Health• Public Safety • Health care
continuum– Providers of
services that support the hospital
• Private entities
• Local / regional / state emergency management agencies
• Volunteer Agencies• Providers of critical
services• Stakeholders
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• Hospitals should plan collaboratively with community responders
• Establish and rehearse pre-event mutual aid agreements for effective response
• Identify gaps and strengths in overall response and recovery
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Exercise
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• Hotwash– Information collection immediately following
operational period/shift/end of incident• Incident Debriefing
– Data collection after response complete• After-Action Report
– Evaluate response and recovery operations – Identify specific strengths, weaknesses, and
strategies
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• Obtaining immediate feedback on response.• Questions posed to elicit feedback
– How did it go?– What went well? What worked for you?– What did not work?– What would you change? What possible solutions
can you suggest?– What tools or aids did you lack?– How could the response been improved?– What themes emerged?
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• Facilitator stimulates productive discussion– Focus on the issues, analysis, and recommendations
• What went right• What went wrong• How to improve
– Provide positive feedback and validate reactions– Focus on the process
• Personnel review timeline of event• Misconceptions or misunderstandings
clarified• Planning Section manages Incident
Debriefing documentation
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• Documentation of exercise and response activities
• Identification of operational successes and deficiencies during response and recovery
• Analysis of evaluation findings to determine effectiveness and efficiency of Emergency Operations Plan
• Develop Improvement Plan250
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• The Emergency Program Manager is responsible for completion of After Action Report
• The Planning Section Chief assists with After Action Report by providing information, data and incident review information
• The hospital should participate in community’s after-action processes
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• Collection of objective, authoritative, and relevant data and observations
• Synthesis of collected data and observations into useful information
• Development of a report that provides a description of incident or exercise in a narrative• Describes objective issues, both positive and
negative• Develop actionable recommendations to
improve Emergency Operations Plan252
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• During the after-action process, a plan must be developed to improve or correct response and recovery
• Improvement Plans may include– Revision of the EOP and SOPs– Development of additional plans, policies
and procedures– Purchase of equipment, supplies, systems– Conducting additional training and
exercising– Provide feedback to staff, administration
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• Organization learning is an element of the recovery process
• After action reporting includes– Debriefing– Incident Review– Develop After Action Report
• Improvement planning– Effecting changes and improvements from
lessons learned– Validate the effectiveness of the EOP
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Knowledge Center®
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