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.

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

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

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. 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, 68 F, no winds

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?

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

Which Positions to Activate?

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Immediate Time Period

Position
Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
Medical-Technical Specialist:
Chemical

Operations Section Chief

Medical Care Branch Director
Infrastructure Branch Director
Security Branch Director
HazMat Branch Director
Patient Family Assistance
Branch Dir.
Planning Section Chief
Resources Unit Leader
Situation Unit Leader
Documentation Unit Leader
Logistics Section Chief
Service Branch Director
Support Branch Director
Labor Pool & Credentialing Unit
Leader

Immedi
ate
X
X
X
X
X

Intermed
iate
X
X
X
X
X

Exten
ded
X
X
X
X
X

Recovery

X
X
X
X
X

X
X
X
X
X
X

X
X
X
X
X
X

X
X
X
X
X
X

X
X
X

X
X
X

X
X
X
X

X
X
X
X

X
X
X
X

X
X
X
X

X
X

X
X
X

X
X
X

X
X
X

X
X

X
X
X
X
X

Finance /Administration
Section Chief
Time Unit Leader
Procurement Unit Leader
Compensation/Claims Unit
Leader
Cost Unit Leader

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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
& Incident Objectives
Identify Incident 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 Incident:
Provide safe and effective decontamination
of incoming contaminated patients
Protect patients, staff, and the hospital from
contamination and safely restore normal
operations
Communicate effectively with the local
Emergency Operations Center and
emergency response partners
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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 215A 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 Branch/Section Objectives

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)
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Branch/Section Objectives
A common problem during exercises is that
Sections/Branches dont develop their
objectives promptly
Report top 3 objectives

22

Incident Action Planning

Step 5: Determine Strategies & Tactics

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

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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
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 215A - Incident Action Plan Safety Analysis

The Planning Section compiles the forms to create the Incident Action Plans

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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

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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

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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 Branch/Section
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?

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Application of
Incident Action Plan & Forms:
Chemical Attack
developed by the
California Hospital Associations
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.

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