1. 1 Application of Incident Action Plan and Forms – Hostage/Barricade Hospital Incident Command System This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital Association This course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U.S. Department of Health & Human Services Assistant Secretary for Preparedness & Response Hospital Preparedness Program and awarded by the California Department of Public Health. No part of this course or its materials shall be copied or utilized for monetary gain.

2. 2 Demonstrate the Incident Action Planning Process Demonstrate the use of HICS Forms Implement the use of the Incident Response Guides Objectives

3. 3 Scenario Based Implementation Discuss and rehearse practical implementation of the Incident Action Planning process utilizing HICS forms and the Incident Response Guides Utilize a “Table Top” learning process

4. 4 Incident Action Planning 1.Assess the Situation 2.Set the Operational Period 3.Determine Safety Priorities & Establish Incident Objectives 4.Determine Branch/Section Objectives 5.Develop Strategies & Tactics 6.Determine Needed Resources 7.Issue Assignments 8.Implement Actions 9.Reassess & Adjust Plans

5. 5 Scenario A patient’s son has been very upset about his mothers condition. She is in ICU and may die. On each visit, he is increasingly agitated and demands information from the staff. On today’s visit the son seems calmer. However, upon seeing his mother he becomes agitated, demanding to see the doctor. The nurses are attempting to calm him, but he becomes increasingly agitated.

6. 6 He pulls 2 handguns from his jacket and fires twice into the ceiling. A security guard rushes into the unit and the gunman shoots him in the leg. The gunman demands that staff move equipment and beds to barricade the doors and announces that he will kill anyone who gets in his way and demands to see his mother’s physician. The ICU is full and there are visitors at the bedsides. Scenario

7. 7 An employee escapes from the ICU and notifies security Power and communications services are functioning normally in the area Time: 1400 Weather: Clear, 75º F, no winds Scenario

8. 8 Local law enforcement is immediately notified Is this an incident? What are your first actions? Who is in charge? First Actions

9. 9 Use HICS form 214: Operational Log Complete HICS form 201: Incident Briefing Event History and Current Actions Summary Begin form 202: Incident Objectives Weather/environmental implications for period Step 1: Assess the Situation Incident Action Planning

10. 10 Which Positions to Activate?

11. 11 Immediate Time Period PositionImmediateIntermediate Extende d Recovery Incident CommanderXXXX Public Information OfficerXXXX Liaison OfficerXXXX Safety OfficerXXXX Operations Section ChiefXXXX Medical Care Branch DirectorXXXX Security Branch DirectorXXXX Law Enforcement Interface Unit LeaderXXXX Patient Family Assistance Branch Dir. XXX Planning Section ChiefXXXX Resources Unit Leader XXX Situation Unit LeaderXXXX Documentation Unit LeaderXXXX Demobilization Unit Leader XXX Logistics Section ChiefXXXX Support Branch DirectorXXXX Finance /Administration Section ChiefXXXX Time Unit Leader XXX Procurement Unit Leader XX Compensation/Claims Unit Leader X Cost Unit LeaderXXXX

12. 12 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

13. 13 HICS form 202: Incident Objectives Operational Period Date/Time Incident Commander sets the Operational Period Based on number of simultaneous activities How quickly the situation is changing An Operational Period breaks the incident down into manageable timeframes Step 2: Set the Operational Period Incident Action Planning

14. 14 Identify Command & Control Objectives (these are the overarching objectives that will last throughout the whole response) HICS form 202: Incident Objectives Step 3: Determine Safety Priorities & Establish Incident Objectives Incident Action Planning

15. 15 Utilize the Incident Response Guide Hostage/Barricade: Ensure the safety of patients, staff, and visitors Maintain communications with staff, patients, visitors, and the media Coordinate response, release of information, and ongoing operations with law enforcement Provide behavioral health support and stress management services to patients, staff, and visitors Return to normal operations as quickly as possible Control Objectives

16. 16 It has been 20 minutes since the gunman barricaded the ICU Law enforcement has arrived at the hospital and is in communication with the ICU SWAT team is responding Scenario Update # 1

17. 17 Assess the Safety issues What hazards exist and what precautions need to be taken Ensure safe evacuation of immediate area surrounding the unit Ensure safety of patients, visitors, staff in non- impacted areas Mitigate panic Complete form 215A – Incident Action Plan Safety Analysis Side Note: Safety Officer Tasks

18. 18 Prepare a statement for the media Prepare a statement for the staff, patients and visitors (e.g., situation, status, safety precautions, next update time) The statements need approval from the Incident Commander Coordinate consistent messaging with the Joint Information Center (JIC) or with law enforcement PIO Side Note: Public Information Officer Tasks

19. 19 Who or what entity operates as the county contact/MHOAC, and how do you contact? Who should be notified of the situation? Who should be notified of hospital status? Bed status? How? Who is the source of resources in your local plan? (e.g., local EMS DOC, PHD DOC, County/City EOC) Needs should be determined prior to the incident Side Note: Liaison Officer

20. 20 Utilize HICS forms Form 214 - Operational Log Side Note: Documenting your Actions

21. 21 Document on HICS 204 – Assignment List They are based on the Incident Objectives These are based on what is desired to be achieved by the Section in that operational period Objectives need to be SMART (Simple, Measurable, Achievable, Realistic, Time Sensitive & Task Oriented) Incident Action Planning Step 4: Determine Branch/Section Objectives

22. 22 A common problem during exercises is that Sections/Branches don’t develop their objectives promptly Branch/Section Objectives

23. 23 Strategies & Tactics are how your Branch/Section is going to achieve the objectives What actions do you need to take? Use your facility response plans and Incident Response Guides Record Strategies & Tactics on form 204 – Branch Assignment List Incident Action Planning Step 5: Determine Strategies & Tactics

24. 24 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: Resources assigned (form 204) Resource requests (messages on form 213) Actions taken to obtain and utilize resources (form 214) Step 6: Determine Needed Resources Incident Action Planning

25. 25 Who will be assigned to the units? Fill in the assignments on form 204 – Assignment List Are there other branches that need activated? Step 7: Issue Assignments Incident Action Planning

26. 26 For the first Operational Period the Incident Action Plan should be done within 30-45 minutes What makes up the Incident Action Plan? Form 201 - Incident Briefing Form 202 - Incident Objectives Form 203 - Incident Assignments Form 204 - Branch Assignments Form 215A - Incident Action Plan Safety Analysis The Planning Section compiles the forms to create the Incident Action Plans Incident Action Planning

27. 27 IAP Quick Start New form Can be used for small incidents Or for a rapid start to a large incident and then expand out on individual HICS forms Great for smaller pre-planned events

28. 28 IAP Cover Sheet Can be used for the IAP Quick Start or full Incident Action Plan forms Can make different colors if you want to differentiate Operational Periods

29. 29 Put your activities / plans into action What are some of these activities? Step 8: Implement Actions Incident Action Planning

30. 30 It is now 1530 – 1.5 hrs into the incident The gunman has released the wounded security guard. He has been received in the Emergency Department. No other hostages have been released What are your major concerns? Scenario Update #2

31. 31 Towards the end of the operational period, you will need to evaluate status Repeat steps 1-8 Update the forms Evaluate and/or update your Branch/Section Objectives This creates your Incident Action Plan (game plan) for the next operational period Step 9: Reassess & Adjust Plans Incident Action Planning

32. 32 It is now 4 hours into the incident The gunman has surrendered to law enforcement All hostages are released and safe What issues should be considered? Scenario Update #3

33. 33 What are things we need to remember to do? Share information Recovery / Restoration After Action Report Corrective Actions Plan How are we doing?

34. 34 Questions?

35. 35 developed by the California Hospital Association’s Hospital Preparedness Program www.calhospitalprepare.org HICS Basics Part 2 Application of Incident Action Plan and Forms Hostage/Barricade This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital Association This course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U.S. Department of Health & Human Services Assistant Secretary for Preparedness & Response Hospital Preparedness Program and awarded by the California Department of Public Health. No part of this course or its materials shall be copied or utilized for monetary gain.

36. 36 IAP Quick Start New form Can be used for small incidents Or for a rapid start to a large incident and then expand out on individual HICS forms Great for smaller pre-planned events

37. 37 IAP Cover Sheet Can be used for the IAP Quick Start or full Incident Action Plan forms Can make different colors if you want to differentiate Operational Periods