1. Presented by Dr. Tracy L. Buchman, DHA, CHPA, CHSP National Director, Healthcare Emergency Management Using the Hospital Incident Command System (HICS) Forms: Which Ones, When and Why

2. Session Objectives Determine the appropriate HICS Forms to use in hospital exercises and actual events Demonstrate the use of HICS Forms by completing them appropriately for given scenarios Explain the rationale for complete, accurate, and legible ICS Forms to FEMA after a real event

3. Hospital Incident Command System Logical management structure Defined responsibilities Clear reporting channels A common nomenclature Incident Command System that helps unify hospitals with other emergency responders by using: Incident Management Team Chart All hazard approach Incident Action Planning Updated Job Action Sheet Incident Planning Guides Incident Response Guides Revised Forms Promotes Recovery

4. Basic Incident Command Structure Incident Commander Planning Section Chief Logistics Section Chief Operations Section Chief Finance/ Administration Section Chief Public Information Officer Liaison Officer Medical/ Technical Specialist(s) Safety Officer

5. Internal Guides Bomb Threat Evacuation Fire HazMat Spill Hospital Overload Hostage/Barricade Infant/child abduction Internal flooding Loss of HVAC Loss of Power Loss of Water Severe weather Work stoppage External Guides Nuclear Detonation Biological attack - Anthrax Biological disease outbreak -Pandemic Influenza Biological Attack – Plague Chemical Attack – Blister Agent Chemical Attack – Toxic Industrial Chemicals Chemical Attack - Nerve agent Chemical Attack – Chlorine Natural Disaster – Earthquake Natural Disaster – Hurricane Radiological Attack – RDD Explosives Attack – IED Biological Attack – Food Contamination Cyber Attack Incident Planning and Response Guides

6. Serves as a road map in response: everyone acting from the same plan Serves as foundation for corrective action Ensures consistency and compliance with regulatory guidelines Complies with documentation for FEMA reimbursement HICS Forms

7. So…Which Ones, When and Why?

8. No.NameResponsible 201Incident BriefingIncident Commander 202Incident ObjectivesSection Chiefs 203Organizational Assignment ListResource Unit Leader 204Branch Assignment ListBranch Directors 205Communications LogCommunications Unit Leader 206Staff Medical PlanSupport Branch Director 207Organization ChartIncident Commander 213Incident Message FormAll Positions 214Operational LogCommand Staff, General Staff, & Branch Directors 251Facility System Status ReportInfrastructure Branch Director

9. No.NameResponsible 252Section Personnel Time SheetSection Chiefs 253Volunteer Staff RegistrationLabor Pool & Credentialing Unit Leader 254Disaster Victim / Pt TrackingPatient Tracking Manager 255Master Pt Evacuation TrackingPatient Tracking Manager 256Procurement Summary Report Procurement Unit Leader 257Resource Accounting RecordSection Chiefs 258Hospital Resource DirectoryResource Unit Leader 259Hospital Casualty / Fatality Report Patient Tracking Manager 260Patient Evacuation Tracking Form Inpt Unit Leader Outpt Unit Leader, Casualty Care Unit Leader 261Incident Action Plan Safety Analysis Safety Officer

10. 10 QuestionsDocument When did we activate our hospital plan?HICS 201 Were any patients impacted?HICS 201, 202 Did we notify patients, families and employees?HICS 201, 202, 214 How many staff worked on this response?HICS 203, 204, 252 Were patients moved to another part of the hospital?HICS 254 Were there any safety issues identified in this event?HICS 261 What is the financial impact on the hospital?HICS 256, 252, 257 What time was the pharmacy instructed to close?HICS 213, 214 What was the impact of the power failure across the hospital? Facility Status Report Were engineers or power officials from outside agencies integrated into the command structure? HICS 203 How many staff were used in this response? What actions did they take? HICS 203, 204, 214, 252

11. Job Action Sheet (JAS) Documents / Tools: Operations Chief 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

12. 12 Incident Action Plan (IAP) IAP developed ASAP after the HCC is operational It becomes the preliminary guidance for a defined, short operational period There is no specific Incident Action Plan form The IAP is made up of: HICS Form 201 – Incident Briefing HICS Form 202 – Incident Objectives HICS Form 203 – Organizational Assignment List HICS Form 204 - Staff Assignment List HICS Form 261 – Incident Action Plan Safety Analysis

13. HICS 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

14. HICS 201 – Incident Briefing Instructions Print legibly and enter complete information  Incident Name  Date of briefing  Time of Briefing  Event History and Current Actions Taken  Current Organization  Notes (warnings, directives, etc.)  Prepared by (name and position)  Facility Name

15. Other Commonly Used Forms  HICS Form 207 – Organization Chart (IMT Chart)  HICS Form 213 – Incident Message Form  HICS Form 214 – Operational Log  HICS Form 251 – Facility System Status Report  HICS Form 254 – Disaster Victim/Patient Tracking Form  HICS Form 260 – Patient Evacuation Tracking Form

16. Section Review The HICS forms: Provide the Incident Management Team with the documents needed to manage a response Assist in communication with external agencies and resources Assist in communication with hospital staff Provide documentation for response and recovery activities

17. Questions?

18. Scenario The Universal Adversary terrorist group has detonated a vehicle bomb in the parking lot of the community’s largest public building during business hours The building is currently hosting a convention with a large number attendees at the event Part of the structure has collapsed and fires are burning throughout the facility. There is severe blast and fire damage to the surrounding buildings There are a large number of people with trauma and burn injuries, including children and many fatalities There are an unknown number of people trapped in the primary and surrounding buildings

19. Your hospital is the closest medical center to the public building, but has not been damaged by the blast. Water, power and communications services are functioning normally in the area. Time: 1400 Weather: Clear, 75º F, Light winds Scenario

20. Victims and uninjured begin arriving at the facility within 15 minutes of the blast. Number of victims expected to arrive: Unknown Is this an event? What are your first actions? Who is in charge? The Power is Disrupted but the Generators are Functioning

21. 1. Understand situation 2. Set Operational Period 3. Determine priorities 4. Establish SMART objectives 5. Select strategies and tactics 6. Identify needed resources 7. Develop and issue assignments 8. Direct, monitor and evaluate response efforts 9. Initiate corrective actions Incident Action Planning

22. Which Positions to Activate?

23. Immediate Time Period

24. Use HICS form 201: Incident Briefing Event History and Current Actions Summary Begin HICS form 214: Operational Log Begin form 202: Incident Objectives Weather/environmental implications for period Step 1: Assess the Situation Incident Action Planning

25.  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

26. HICS form 202: Incident Objectives Operational Period Date/Time Incident Commander sets the Operational Period Based on number of simultaneous activities How quickly the situation is changing An Operational Period breaks the incident down into manageable timeframes Step 2: Setting the Operational Period Incident Action Planning

27. These are the “Control” objectives These are the overarching objectives that will last throughout the whole event Identify Control Objectives (overall priorities) HICS form 202: Incident Objectives Step 3: Determine Overall Priorities Incident Action Planning

28. Utilize the Incident Response Guide Explosives Attack: Prepare for the influx/surge of trauma and burn victims Ensure facility security Prepare for patient triage and medical management Collect forensic evidence for law enforcement Communicate the situation status and information to staff, patients, media and the public Control Objectives

29. It has been 30 minutes since the explosion The ED has received 2 critical burn/trauma patients by private car 20 victims have been triaged 2 immediate 2 delayed 16 minor ED estimates 20 victims waiting for triage EMS reports as many as 200 victims Scenario Update #1

30. Assess the Safety issues What hazards exist and what precautions need to be taken Security Needs (e.g., increased surveillance, secondary device, crowd control) Complete form 261 – Incident Action Plan Safety Analysis Side Note: Safety Officer Tasks

31. HICS form 202 – Incident Objectives Operational period objectives are the objectives for the sections/branches They are based on the control objectives These are based on what is desired to be achieved by the section in that operational period Identify the key objectives for the section for the operational period Objectives need to be measurable Incident Action Planning Step 4: Operational Period Objectives

32. The section’s objectives are compiled onto HICS form 202 – Incident Objectives A common problem during exercises is that sections don’t come up with their objectives promptly Operational Period Objectives

33. How is your section/branch going to achieve the objectives? What actions do you need to take? Use your facility response plans and incident response guides Record on form 204 – Branch Assignments Incident Action Planning Step 5: Strategies and Tactics

34. What units/space needs to be activated? What personnel resources do you need? What equipment and/or supplies do you need? Do you need transport resources? Document Identified Needs: Objectives/strategies/tactics to secure resources (form 204) Actions taken to secure (logged on form 214) Requests made (messages on form 213) Step 6: Identify Resources Incident Action Planning

35. Who will be assigned to the units? Fill in the assignments on form 204 – Branch Assignments Are there other branches that need activated? Step 7: Issue Assignments Incident Action Planning

36. Put your activities / plans into place What are some of these activities? Step 8: Implement Activities Incident Action Planning

37. Towards the end of the operational period, you’ll need to evaluate status Repeat steps 1-8 Update the forms Evaluate and/or update your objectives This creates your incident action plan (game plan) for the next operational period Step 9: Initiate corrective actions Incident Action Planning

38. Risk Management & Insurance Claims

39. Categories of Work ~ Reference Topics There are two types of work eligible for reimbursement through a Public Assistance Grant: Emergency Work Debris Removal Emergency Protective Measures Permanent Work Road Systems and Bridges Water Control Facilities Buildings, Contents, and Equipment Utilities Parks, Recreational, and Other Reference: http://www.fema.gov/government/grant/pa/re_categories.shtm

40. Sumter Regional Hospital ATLANTA, Ga. -- On March 1, 2007, a tornado tore a one-mile wide, six-mile long swath across the community of Americus, Ga. It zeroed in on Sumter Regional Hospital, the area's largest medical facility and major employer. The 143-bed hospital was severely damaged, the adjacent HealthPlex destroyed, 70 patients safely evacuated and some 700 personnel temporarily displaced. On July 31, the Department of Homeland Security's Federal Emergency Management Agency (FEMA) announced it has obligated $9.27 million for interim replacement of the facilities of which $1.88 million will fund the outer shell construction and nearly $7.39 million will be used for interior build-out. FEMA's commitment represents 75 percent of the total estimated cost of $12.36 million. Reference: http://www.fema.gov/news/newsrelease.fema?id=38354

41. Columbus Regional Hospital COLUMBUS, In. -- On June 7, 2008, floodwaters inundated the hospital. The entire basement, containing much of the hospital's medical and lab equipment was filled floor to ceiling with floodwater, mud and silt. In addition, the first floor area sustained heavy damage from the floodwater and mud. The hospital is a regional healthcare facility providing vital services such as surgery and emergency care for multiple counties in the southeastern portion of the state. During the course of a year, the hospital may treat more than 200,000 patients. Columbus Regional also employs 1800 people and is critical to the area's economy. The facility was forced to shut down as a result of the flood and did not reopen until October of 2008. Reference: http://www.fema.gov/news/newsrelease.fema?id=47556

42. Session Summary Determine the appropriate HICS Forms to use in hospital exercises and actual events Demonstrate the use of HICS Forms by completing them appropriately for given scenarios Explain the rationale for complete, accurate, and legible ICS Forms to FEMA after a real event

43. Questions? Dr. Tracy L. Buchman, DHA, CHPA, CHSP National Director, Healthcare Emergency Management HSS Inc. | Email: tbuchman@hss-us.com http://www.linkedin.com/in/tracybuchman Cell 608-567-9536 | Toll Free 877-477-2870