Hospital Incident
Command System
Application of
Incident Action Plan & Forms:
Chemical Attack
This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital 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.
1
Objectives
• Demonstrate the Incident Action Planning
Process
• Demonstrate the use of HICS Forms
• Implement the use of the Incident Response
Guides
2
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
3
Incident Action Planning
1. Assess the Situation
2. Set the Operational Period
3. Determine Safety Priorities & Establish
Control Objectives
4. Determine Operational Period Objectives
5. Determine Strategies & Tactics
6. Determine Needed Resources
7. Issue Assignments
8. Implement Actions
9. Reassess & Adjust Plans
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Scenario
• The 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.
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Scenario
• Based 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.
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Scenario
• Time: 0830
• Weather: Clear, 68º F, no winds
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First Actions
• Within 15 minutes large numbers of
contaminated and worried well are presenting
to the hospital for care.
• Number of victims expected to arrive: Unknown
 Is this an incident?
 What are your first actions?
 Who is in charge?
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Incident Action Planning
Step 1: Assess the Situation
• 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
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Which Positions to Activate?
Incident Commander
Public Information
Officer
Safety
Officer
Liaison
Officer
Medical/Technical
Specialist
Planning
Section Chief
Operations
Section Chief
Staging
Manager
Personnel Staging Team
Vehicle Staging Team
Equipment/Supply
Staging Team
Medication Staging Team
Medical Care
Branch Director
Inpatient Unit
Outpatient Unit
Casualty Care Unit
Mental Health Unit
Clinical Support Services Unit
Patient Registration Unit
Infrastructure
Branch Director
Power/Lighting Unit
Water/Sewer Unit
HVAC Unit
Building/Grounds
Damage Unit
Medical Gases Unit
Medical Devices Unit
Environmental Services Unit
Food Services Unit
HazMat
Branch Director
Detection and Monitoring Unit
Spill Response Unit
Victim Decontamination Unit
Facility/Equipment
Decontamination Unit
Security
Branch Director
Access Control Unit
Crowd Control Unit
Traffic Control Unit
Search Unit
Law Enforcement Interface Unit
Business
Continuity
Branch Director
Information Technology Unit
Service Continuity Unit
Records Preservation Unit
Business Function Relocation Unit
Biological/Infectious Disease
Chemical
Radiological
Clinic Administration
Hospital Administration
Legal Affairs
Risk Management
Medical Staff
Pediatric Care
Medical Ethicist
Finance/
Administration
Section Chief
Logistics
Section Chief
Resources
Unit Leader
Personnel Tracking
Materiel Tracking
Service
Branch Director
Communications Unit
IT/IS Unit
Staff Food & Water Unit
Time
Unit Leader
Situation
Unit Leader
Patient Tracking
Bed Tracking
Support
Branch Director
Employee Health &
Well-Being Unit
Family Care Unit
Supply Unit
Facilities Unit
Transportation Unit
Labor Pool &
Credentialing Unit
Procurement
Unit Leader
Documentation
Unit Leader
Demobilization
Unit Leader
Compensation/
Claims
Unit Leader
Cost
Unit Leader
10
Immediate Time Period
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Naming 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 forms
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Incident Action Planning
Step 2: Set the Operational Period
• 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
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Incident Action Planning
Step 3: Determine Safety Priorities
& Control Objectives
• Identify Command & Control Objectives
(these are the overarching objectives that will
last throughout the whole response)
• HICS form 202: Incident Objectives
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Control Objectives
Utilize the Incident Response Guide
Chemical Attack:
• Identify, triage, isolate and treat contaminated/
exposed patients
• Safely admit a large number of
contaminated/exposed patients while protecting
your staff and facility
• Accurately track patients through the healthcare
system
• Assure safety and security of the facility
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Scenario 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.
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Side Note:
Safety Officer Tasks
• Assess the Safety issues
• What hazards exist and what precautions need
to be taken
 Potential contamination of the facility, activate
limited access
 Ensure safety of staff receiving victims,
appropriate PPE
 Potential of hospital to be overwhelmed by
incoming victims, insure security response
• Complete form 261 – Incident Action Plan
Safety Analysis
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Side Note:
Public Information Officer Tasks
• 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)
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Side 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
incident
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Side Note:
Documenting your Actions
• Utilize HICS forms
• Form 214 - Operational Log
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Incident Action Planning
Step 4: Determine Operational
Period Objectives
• Document on HICS 204 – Branch Assignment
List
• They are based on the Control 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)
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Operational Period Objectives
• A common problem during exercises is that
Sections/Branches don’t develop their
objectives promptly
• Report top 3 objectives
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Incident Action Planning
Step 5: Determine Strategies & Tactics
• Strategies & tactics are how your Section/Branch
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
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Incident Action Planning
Step 6: Determine Needed Resources
• Does 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)
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Incident Action Planning
Step 7: Issue Assignments
• Who will be assigned to the units?
• Fill in the assignments on form 204 – Branch
Assignment List
• Are there other branches that need activated?
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Incident Action Planning
• 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 261 - Incident Action Plan Safety Analysis
• The Planning Section compiles the forms to create
the Incident Action Plans
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Incident Action Planning
Step 8: Implement Actions
• Put your activities / plans into action
• What are some of these activities?
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Scenario 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 distress
• Decontamination of victims continues
• EMS has transported 2 critical victims to your
hospital
• What are your major concerns?
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Incident Action Planning
Step 9: Reassess & Adjust Plans
• 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 Operational Period
Objectives
• This creates your Incident Action Plan (game plan)
for the next operational period
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Scenario Update #3
• It is now 4 hours into the incident
• All victims have been transported
• Hospital decontamination is completed and
there is a large volume of victim belongings and
grey water collection
• Universal Adversary has claimed responsibility
and states a secondary device is in place
• What issues should be considered?
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How are we doing?
What are things we need to remember to do?
 Share information
 Recovery / Restoration
 After Action Report
 Corrective Actions Plan
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Questions?
32
Application of
Incident Action Plan & Forms:
Chemical Attack
developed by the
California Hospital Association’s
Hospital Preparedness Program
www.calhospitalprepare.org
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.
33