Hospital Incident

Command System

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.

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. Develop Strategies & Tactics
6. Determine Needed Resources
7. Issue Assignments
8. Implement Actions
9. Reassess & Adjust Plans
4

Scenario
A patients 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 todays 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.

Scenario
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 mothers physician.
The ICU is full and there are visitors at the
bedsides.

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

First Actions
Local law enforcement is immediately notified

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?

10

Immediate Time Period

Position
Incident Commander
Public Information Officer
Liaison Officer
Safety Officer

Operations Section Chief

Medical Care Branch Director
Security Branch Director
Law Enforcement Interface Unit
Leader
Patient Family Assistance
Branch Dir.
Planning Section Chief
Resources Unit Leader
Situation Unit Leader
Documentation Unit Leader
Demobilization Unit Leader
Logistics Section Chief
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

Intermedi
ate
X
X
X
X

Exten
ded
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

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
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
13

Incident Action Planning

Step 3: Determine Safety Priorities &
Establish Incident Objectives
Identify Command & Control 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
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,

15

Scenario Update #1
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

16

Side Note:
Safety Officer Tasks
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
17

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) or with law
enforcement PIO
18

Side Note:
Liaison Officer
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

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
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)
21

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

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

23

Incident Action Planning

Step 6: Determine Needed Resources
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)
24

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?

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
Form
Form
Form
Form

201 - Incident Briefing

202 - Incident Objectives
203 - Incident Assignments
204 - Branch Assignments
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 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?

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
Update the forms
Evaluate and/or update your Branch/Section
Objectives
This creates your Incident Action Plan (game plan)
for the next operational period
31

Scenario Update #3
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?

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
Hostage/Barricade
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

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

36

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

37