Hospital Incident

Command System

Application of
Incident Action Plan and
Forms Earthquake

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

Scenario

A 7.8-magnitude earthquake occurs along a fault zone

50 miles from your hospital. Ground shaking occurs
impacting a 6 county region. Moderate to major
damage is reported for 200 square miles. Multiple
severe aftershocks are expected for days and weeks
after the initial earthquake.

Hundreds of thousands of people sustain mild to

severe injuries. Hospitals sustain moderate to severe
damage to their infrastructure. EMS is overwhelmed
with request for assistance. Transport to hospitals is
difficult due to debris in roadways.
5

Scenario

Your hospital has sustained moderate to severe

damage.

The Emergency Department and outpatient

surgery are non-functional due to damage and
must be relocated.

Main water and power services are disrupted,

however emergency power (generators) is
functioning. Telephone and internet service is
down.
6

Scenario
Time: 0830

Weather: Clear, 68 F, no winds

Within 15 minutes large numbers of injured are

presenting to the hospital for care. Many who
are not injured seek shelter and reassurance
from medical providers.

First Actions

Time until restoration of main power, water,

phone, internet: 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
9

Which Positions to Activate?

10

Immediate Time Period

Position
Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
Medical-Technical Specialist:
Seismic or Structural Engineer

Operations Section Chief

Medical Care Branch Director
Infrastructure Branch Director
Security Branch Director
Business Continuity Branch
Director
Patient Family Assistance
Branch Dir.
Planning Section Chief
Resources Unit Leader
Situation Unit Leader
Documentation Unit Leader
Demobilization Unit Leader
Logistics Section Chief
Service Branch Director
Support Branch Director
Finance /Administration
Section Chief
Time Unit Leader
Procurement Unit Leader
Compensation/Claims Unit
Leader
Cost Unit Leader

Immedi
ate
X
X
X
X

Intermed
iate
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

11

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

12

Incident Action Planning

Step 2: Set the Operational Period

HICS form 202: Incident Objectives

Incident Commander sets the Operational

Period

Operational Period Date/Time

o Based on number of simultaneous activities

o How quickly the situation is changing

An Operational Period breaks the incident

down into manageable timeframes
13

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

14

Control Objectives
Utilize the Incident Response Guide
Earthquake:

Provide for patient care and management

Provide for the safety of patients, staff,
families, and visitors
Provide for continuing operational status of
the hospital or safe evacuation from the
hospital

15

Scenario Update #1

It has been 30 minutes since the incident.

Other areas of the hospital are under

assessment, however structural damage is not
expected to result in total evacuation

There have been multiple aftershocks

The emergency department and outpatient
surgery have been determined to be unsafe and
must be evacuated

16

Side Note:
Safety Officer Tasks

Assess the Safety issues

What hazards exist and what precautions need
to be taken
Ensure safe entry/exit of essential personnel to and
from hospital
Ensure safety of patients, visitors, staff
Ensure all essential life support is on emergency power

Complete form 215A Incident Action Plan

Safety Analysis

17

Side Note:
Public Information Officer Tasks

Prepare a statement for the media

The statements need approval from the Incident

Commander

Coordinate consistent messaging with the Joint

Information Center (JIC) or with law enforcement PIO

Prepare a statement for the staff, patients and

visitors (e.g., situation, status, safety precautions,
next update time)

18

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?

Key contacts should be determined prior to the incident

Who should be notified of hospital status? Bed status? How?

Who is the source of government resources in your local plan?
(e.g., local EMS Department Operations Center (DOC), PHD
DOC, County/City Emergency Operations Center)

19

Side Note:
Documenting your Actions

Utilize HICS forms

Form 214 - Operational Log

20

Incident Action Planning

Step 4: Determine Branch/Section Objectives

Document on HICS 204 Assignment List

Objectives need to be SMART (Simple,

Measurable, Achievable, Realistic, Time Sensitive
& Task Oriented)

They are based on the Incident Objectives

These are based on what is desired to be
achieved by the Section in that operational period

21

Operational Period 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?

Record strategies & tactics on form 204 Branch

Assignment List

Use your facility response plans and Incident

Response Guides

23

Incident Action Planning

Step 6: Determine Needed Resources

Where can patients be moved to?

What personnel resources do you need?
What equipment and/or supplies do you need?
What resources do you need in the patient
collection/holding area?
What communication devices do you need?
Document resource activities:

Resources assigned (form 204)

Resource requests (form 213)
Actions taken to utilize and obtain resources (form 214)
24

Incident Action Planning

Step 7: Issue Assignments

Who will be assigned to the units?

Are there other branches that need activated?

Fill in the assignments on form 204

Assignment List

25

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

26

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

27

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

28

Incident Action Planning

Step 8: Implement Actions

Put your activities / plans into action

What are some of these activities?

29

Scenario Update #2

It is now 1000 1.5 hrs into the incident

Main power restoration expected in 24 hours

Utility workers expect restore water service to

the hospital within 10 12 hours

What are your major concerns?

30

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

This creates your Incident Action Plan (game

plan) for the next operational period

Update the forms

Evaluate and/or update your Branch/Section
Objectives

31

Scenario Update #3

It is now 4 hours into the incident

What issues should be considered?

Utility repair personnel have encountered

complications and report main power may not
be restored for 3 days, potentially outlasting
your generator fuel stores

32

How are we doing?

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

33

Questions?

34

HICS Basics Part 2

Application of
Incident Action Plan and Forms
Earthquake
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.

35