Presentation on theme: "Application of Incident Action Plan & Forms: Chemical Attack"— Presentation transcript:
1Application of Incident Action Plan & Forms: Chemical Attack Hospital Incident Command SystemApplication ofIncident Action Plan & Forms:Chemical AttackThis 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.
2Objectives Demonstrate the Incident Action Planning Process Demonstrate the use of HICS FormsImplement the use of the Incident Response Guides
3Scenario Based Implementation Discuss and rehearse practical implementation of the Incident Action Planning process utilizing HICS forms and the Incident Response GuidesUtilize a “Table Top” learning process
4Incident Action Planning Assess the SituationSet the Operational PeriodDetermine Safety Priorities & Establish Control ObjectivesDetermine Operational Period ObjectivesDetermine Strategies & TacticsDetermine Needed ResourcesIssue AssignmentsImplement ActionsReassess & Adjust PlansWe will be using the Incident Action Planning Process to walk through our scenarioUsually multiple things are being done at once but we are going to be linear and go through one thing at a timeReference the CHA IAP Checklist
5ScenarioThe Universal Adversary terrorist group releases Sarin into the ventilation systems of three large commercial office buildings. Within minutes, people develop runny nose, watery eyes, coughing, chest tightness, blurred vision, drooling and sweating. Some develop severe muscle twitching, confusion, nausea and vomiting. Many have died.People are self evacuating the building and there are numerous fall/crush injuries. EMS has initiated triage and performing decontamination outside of the buildings.
6ScenarioBased on the symptoms, EMS requests large quantities of nerve agent antidotes to be brought to the scene. Hazmat confirms Sarin is the causative agent.Your hospital is the closest hospital about 2 miles from the scene. Many victims self evacuate and drive to your hospital. EMS also begins transporting the most critical victims to your facility with a short ETA. It is unknown if the victims have been fully decontaminated.
7ScenarioTime: 0830Weather: Clear, 68º F, no winds
8First ActionsWithin 15 minutes large numbers of contaminated and worried well are presenting to the hospital for care.Number of victims expected to arrive: UnknownIs this an incident?What are your first actions?Who is in charge?Start with 201Is this an incident?YesFirst Actions –Appropriate person takes role as Incident CommanderActivates EOP, HICS, HCCConduct situational assessmentDirect victims to decontamination area, do not allow into facilityAssure protection of first receiversActivate Decontamination team and/or request Fire Dept. assistance depending on level of capabilitySet up decontaminationPrioritize victims for decontaminationMonitor decontamination staff (Decontamination Safety Officer & Medical Monitoring)Assure all staff engaged in receiving and caring for patients have appropriate PPEDetermine where triage and initial treatment will take placeObtain Nerve Agent antidote supply
9Incident Action Planning Step 1: Assess the SituationUse HICS form 214: Operational LogComplete HICS form 201: Incident BriefingEvent History and Current Actions SummaryBegin form 202: Incident ObjectivesWeather/environmental implications for periodRefer to forms in handoutsHave the Incident Commander give you the summary to put on the 201Put the weather on the 202
10Which Positions to Activate? Based on this situation, what needs to be activated?Use the Chemical Attack – Nerve Agent Incident Response GuideCommand StaffSection Chiefs (consider finance)Infrastructure Branch DirectorMedical Care Branch DirectorHazmat Branch DirectorSecurity Branch DirectorSituation Unit LeaderSupport Branch DirectorHow long did that take us to figure out? (go to next slide)
11Immediate Time PeriodLook at the IRG for Chemical Attack (towards the back of the handout)This is a great cheat sheet, use the IRG to figure out what positions to activate
12Naming the Incident 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 formsHave the incident commander name the incident
13Incident Action Planning Step 2: Set the Operational PeriodHICS form 202: Incident ObjectivesOperational Period Date/TimeIncident Commander sets the Operational PeriodBased on number of simultaneous activitiesHow quickly the situation is changingAn Operational Period breaks the incident down into manageable timeframesIncident Commander should state the Operational PeriodIn a situation that is not stable, still changing – it should be 2 hours. Usually the 1st Op Period is 2 hours.
14Incident Action Planning Step 3: Determine Safety Priorities & Control ObjectivesIdentify Command & Control Objectives (these are the overarching objectives that will last throughout the whole response)HICS form 202: Incident ObjectivesControl objectives –Identify, decontaminate, triage, and treat contaminated/exposed patientsAssure safety and security of staff, patients and visitors.Accurately track patients through the healthcare systemCommunicate to community response partners (EMS, PHD, local fire and law enforcement)Maintain security and safety of facilityAfter they come up with some ideas then you can show them objectives on the IRG – next slideSafety Officer addresses safety priorities on the HICS form 261 IAP Safety Analysis
15Control Objectives Utilize the Incident Response Guide Chemical Attack:Identify, triage, isolate and treat contaminated/ exposed patientsSafely admit a large number of contaminated/exposed patients while protecting your staff and facilityAccurately track patients through the healthcare systemAssure safety and security of the facilityFill in what they decide on the 202
16Scenario Update #1 It has been 30 minutes since the event: Approximately 40 ambulatory self-transported victims have arrived at the hospital claiming to be in the vicinity of the release.Hospital decontamination set up is complete and decontamination has been started.EMS reports they have approximately 50 victims in moderate to severe distress. Field decontamination is in process. There are unknown numbers minor exposed/contaminated. EMS is ready to transport 4 critical victims.
17Side Note: Safety Officer Tasks Assess the Safety issuesWhat hazards exist and what precautions need to be takenPotential contamination of the facility, activate limited accessEnsure safety of staff receiving victims, appropriate PPEPotential of hospital to be overwhelmed by incoming victims, insure security responseComplete form 261 – Incident Action Plan Safety AnalysisSafety Officer to work on the 261
18Side Note: Public Information Officer Tasks Prepare a statement for the mediaPrepare a statement for the staff, patients and visitors (e.g., situation, status, safety precautions, next update time)The statements need approval from the Incident CommanderCoordinate consistent messaging with the Joint Information Center (JIC)
19Side Note: Liaison Officer Who or what entity operates as the county contact/MHOAC, and how do you make contact?Who else should be notified of the situation?Who should be notified of hospital status? Bed status? Decontamination capability? How?Who is the source of government resources in your local plan? (e.g., Fire department, local EMS Department Operations Center (DOC), PHD DOC, County/City Emergency Operations Center)Key contacts should be determined prior to the incidentIf there are immediate needs for decontamination, security, or pharmaceutical resources, where and how will these be obtained?Is there a need for EMS diversion and who needs to be notified?What other resources could be requested?Note: “Situation” refers to the event summery. Hospital “status” refers to functioning, partial functioning, non-functioning or could relate to diversion status.
20Side Note: Documenting your Actions Utilize HICS formsForm Operational Log
21Incident Action Planning Step 4: Determine Operational Period ObjectivesDocument on HICS 204 – Branch Assignment ListThey are based on the Control ObjectivesThese are based on what is desired to be achieved by the Section in that operational periodObjectives need to be SMART (Simple, Measurable, Achievable, Realistic, Time Sensitive & Task Oriented)5 – 10 min for students (Section Chiefs) to develop 3-4 objectives. PIO does PIO report. Liaison officer making calls. Safety Officer – form 261People get confused about Sections/Branches use. A separate 204 for each Branch, if more than one branch is activated.Have them work on this in their sections. Actually write on a 204
22Operational Period Objectives A common problem during exercises is that Sections/Branches don’t develop their objectives promptlyReport top 3 objectivesHave the groups share their top 3 objectivesSome examples:OperationsImplement decontamination proceduresAdminister antidotes as indicatedProvide triage and care to exposed/injured patientsProtect environment/facility from contaminationEnsure medical monitoring of personnel participating in decontaminationSecure the facilityPlanningTrack patientsDevelop the Incident action plan in collaboration with the Command and General StaffInitiate materiel and personnel tracking proceduresLogisticsObtain and deliver antidotes to decontamination area and emergency departmentDetermine medication, equipment, supply and personnel needsPrepare for receipt, distribution and tracking of external pharmaceutical resourcesProvide mental health support for patients/family/staff/command personnelAssure communications are in place between decontamination unit, emergency department and HCCFinanceTrack costs
23Incident Action Planning Step 5: Determine Strategies & TacticsStrategies & tactics are how your Section/Branch is going to achieve the objectivesWhat actions do you need to take?Use your facility response plans and Incident Response GuidesRecord strategies & tactics on form 204 – Branch Assignment ListAssure decontamination, chemical agent guides, security, surge related policies, plans, procedures are available from the EOP in the Hospital Command Center
24Incident Action Planning Step 6: Determine Needed ResourcesDoes additional space need to be activated?What personnel resources do you need?What equipment and/or supplies/ pharmaceuticals do you need?What resources do you need in the patient collection/decontamination area?What communication devices do you need?Document resource activities:Resources assigned (form 204)Resource requests (form 213)Actions taken to utilize & obtain resources (form 214)Space for holding minor/mild victimsSecurity, decontamination, medical monitoring personnelAntidotes/ValiumDoffing/donning kitsBlanketsCommunication devices (Radios)Hydration for decontamination staff
25Incident Action Planning Step 7: Issue AssignmentsWho will be assigned to the units?Fill in the assignments on form 204 – Branch Assignment ListAre there other branches that need activated?Have them work in groups on their strategies, tactics and assignments for their branches
26Incident Action Planning For the first Operational Period the Incident Action Plan should be done within minutesWhat makes up the Incident Action Plan?Form Incident BriefingForm Incident ObjectivesForm Incident AssignmentsForm Branch AssignmentsForm Incident Action Plan Safety AnalysisThe Planning Section compiles the forms to create the Incident Action PlansAs we did this process, completed the forms – THIS made up our IAPPut a cover on it with the date, time of the Operational Period – process it, share with others
27Incident Action Planning Step 8: Implement ActionsPut your activities / plans into actionWhat are some of these activities?Remind students about monitoring and evaluating activities being implemented
28Scenario Update #2 It is now 1000 – 1.5 hrs into the incident The hospital has received 60 additional ambulatory self-transported victims, 4 in severe distress and 10 in moderate distressDecontamination of victims continuesEMS has transported 2 critical victims to your hospitalWhat are your major concerns?Major Concerns:Continued medical careSecurityHospital contaminationContinued ability to provide decontamination servicesStaff contamination/injuryMedia managementDisruption of servicesPIO messaging to patients, staff, mediaCommunication to governmental agencies (Liaison)
29Incident Action Planning Step 9: Reassess & Adjust PlansTowards the end of the operational period, you will need to evaluate statusRepeat steps 1-8Update the formsEvaluate and/or update your Operational Period ObjectivesThis creates your Incident Action Plan (game plan) for the next operational period
30Scenario Update #3 It is now 4 hours into the incident All victims have been transportedHospital decontamination is completed and there is a large volume of victim belongings and grey water collectionUniversal Adversary has claimed responsibility and states a secondary device is in placeWhat issues should be considered?Security considerationsEvidence collection/Law enforcement communicationHandling of victim belongingsGrey water handling and decontamination zone clean up/recoveryAssessment of decontamination staffFamily reunificationCommunication with local DOC/EOC to determine what resources can be provided to the hospitalStaff CommunicationPublic Information
31How are we doing? What are things we need to remember to do? Share informationRecovery / RestorationAfter Action ReportCorrective Actions Plan
32Questions?Clean-up, part of any event is recovery-put the vests back as they belongPost testEvaluation
33Incident Action Plan & Forms: Application ofIncident Action Plan & Forms:Chemical Attackdeveloped by theCalifornia Hospital Association’sHospital Preparedness ProgramThis 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.