Incident Action Planning and Reporting

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Incident Action Planningand Reporting
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Objectives

• Provide a background on the use of the Incident
  Command System (ICS) by hospitals.
• Describe the VHA operational system.
• Explain the incident action planning and
  reporting processes.

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Primary References

• Emergency Management Principles and Practices
  for Healthcare Systems
• Glossary, Competency Framework, and Curriculum
• Emergency Management Program Guidebook
• Emergency Management Capability Assessment
  Program
• Medical Surge Capacity and Capability (MSCC)
  Handbook
• Available at www.va.gov/emshg

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Emergency Management Program vs. Incident Command
System

• An Emergency Management Program involves
  activities across four phases mitigation,
  preparedness, response and recovery.
• ICS is used to manage the response and recovery
  timeframes.
• An ICS organization operates in parallel to the
  day-to-day agency organizational structure.
• Staffing the ICS should be based on training and
  qualifications.

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ICS in HospitalsCommon Challenges

• How much adaptation is too much?
• Pre-designating hospital management and staff to
  particular ICS positions.
• Identifying who is Incident Commander or
  Operations Chief.
• Explaining how ICS is implemented in response to
  threats or events.

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Comparison VHA Model HICS
2005 VHA EMPG, Operations Section
2006 HICS, Operations Section

• Business Continuity
• Equipment, Plant and Utilities
• Safety and Security
• Health and Medical

• Business Continuity
• Infrastructure
• Security
• Hazardous Materials
• Medical Care

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NIMS Compliance and theVHA Guidance

• The January, 2007 DUSHOM Memorandum established
• NIMS requirements apply to VA Facilities.
• A 120-day compliance period.
• Identified which staff are appropriate to serve
  on an IMT, and whom are strongly recommended to
  complete NIMS-required training.
• The 2009 EMP Guidebook
• How the 14 elements can be accomplished through
  the nine-step program development process is
  explained.

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VHA ICS ModelManagement Elements

• Agency Executive 10, VISN and VAMC Directors
• Policy Coordination Entity - Program Officials
  and Key Operating Unit Managers
• Incident Management/Support Team - Staff who work
  in
• Emergency Operations Centers (EOCs), or
• Response Support Unit (RSU)

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Agency Executive Role

• Continues to run the organization and
  participates in incident action planning.
• Articulates policy, direction and scope of
  authority to the Incident Management Team (IMT)
  Commander.
• Evaluates effectiveness and correct deficiencies.
• Determines priorities across and within
  incidents.

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Policy Coordinating Entity Role

• Also continues with day-to-day program
  management, but convenes as needed to advise the
  Agency Executive and IMT Commander.
• Provides technical guidance to support policies
  or actions during emergencies.
• Consists of program representatives with
  decision-making authority.
• Coordinates issues between program areas and
  across the system.

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Incident Management Team Role

• Operates from an Emergency Operations Center.
• Conducts incident action planning efforts.
• Manages response activities.
• Compiles, authenticates and publishes regular
  summary situation status and resource status
  information.
• Coordinates through liaison officers with other
  agencies.

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Response Support Unit Role

• An IMT that is deployed into the disaster area to
  provide command, control and coordination of VHA
  resources that are assigned to support internal
  and external mission assignments.
• Coordination with external operational
  authorities, VISNs VAMCs, and VHA 10N.
• Mission and resource tracking.
• Reporting.

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VHACO Role

• Command, control and coordination of internal VHA
  response efforts and external support.
• Coordination with VA, HHS and other Federal
  agencies at the national level.
• Facilitate resolution of policy, financial and
  technical issues.
• Mission and resource tracking.
• Reporting.

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VISN Office Role

• Command, control and coordination of VISN-wide
  incident management activities.
• Coordination with VAMCs, other VISNs, VHACO,
  other Federal agencies at the regional level, and
  the State EOC(s).
• Mission and resource tracking.
• Reporting.

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VA Medical Center Role

• Command, control and management of incidents
  affecting facility service delivery.
• Outreach to veterans.
• Resource support to deployed VHA assets.
• Coordination with CBOCs, other VAMCs, the VISN
  office and local EOCs.
• Mission and resource tracking.
• Reporting.

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Agency Executive
VHA CO
Policy Coordinating Entity
IMT
VHA EOC
Agency Executive
VISN
Policy Coordinating Entity
IMT
VISN EOC
Agency Executive
VAMC
Policy Coordinating Entity
IMT
VAMC EOC
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Determining Which Level is Lead

• Emergency situations that affect continuity of
  patient care operations at a VA Medical Center or
  Community-based Outpatient Clinic (CBOC) will be
  managed by the VA Medical Center Director as the
  lead VHA official.
• The VISN Director becomes the lead VHA official
  when emergency situations affect continuity of
  patient care or access to service delivery at one
  or more VA Medical Centers, although VAMC
  Directors remain responsible for managing local
  operations.

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Lead (cont)

• The Under Secretary for Health becomes the lead
  VHA official when emergency situations either
  require a Presidential declaration VA resources
  are requested under the National Response
  Framework, or the situation has the potential to
  affect VHAs national health care system.

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Incident Action Planning andIncident
ReportingProcesses
Section 10, 2009 EM Program Guidebook vaww.ceosh.m
ed.va.gov
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Phases of an Incident

• Notification
• Advisory
• Alert
• Mobilization
• Initial Response
• Extended Response
• Demobilization
• Return to Readiness

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Life Cycle Stages of an Incident

• Event recognition
• Notification
• Advisory
• Alert
• Activation Mobilization
• Incident Operations
• Initial Response Efforts
• Extended Response
• Demobilization
• Return to Readiness

These actions are guided by the organizations
Emergency Operations Plan (EOP) and incident
specific Guidance.
Response Recovery
After the initial response period, actions are
guided by a management by-objectives process
because requirements are situation-specific.
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Strategies for Effective Management of
Information Time

• Designate operational periods.
• Implement and synchronize planning cycles across
  the organization.
• Establish a conference call schedule that
  supports planning cycles.
• Keep meetings short and focused on
  management-by-objectives.
• Determine reporting forms and deadlines.
• Designate times for updates and briefings.

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Incident Action Planning Cycle

• The operational period is the designated time
  period in which tactical objectives are to be
  accomplished and re-evaluated.
• During each operational period, there are five
  distinct activities that take place.
• Across the national system, it is important to
  establish and synchronize planning cycles in
  order to reduce confusion and the need for
  day-long conference calls.

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Incident Action Planning Cycle Activities

• Situation updates/reporting
• Situation briefing/Shift change
• Management meeting
• Planning meeting
• Operations briefing/implement action plan

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Operations Briefing IMT briefs the
operational leaders on the IAP
12 hour period
Implement Action Plan, Assess Progress
Prepare Operations Briefing
Planning Meeting IMT develops strategies
tactics to accomplish objectives
Situation Reports IAPs Due
Management Meeting Evaluate/revise overall
objectives and priorities
Situation Briefing IMT briefs on the current
status
Shift Change
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Situation Briefing Process

• 1. Plans Coordinates the briefing, sets up
  conference calls, keeps information on point and
  on time.
• 2. Others, listen and think about
• Command Define organizations role, overall
  priorities and objectives for next 24 hours.
• Operations Resources and tactics/assignments
  that may address the apparent issues/problems.
• Logistics Supplies, services that may be
  needed.
• Finance Likely administrative and financial
  issues.

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Management Meeting Process

• Plans convenes meeting.
• Command briefs the Agency Executive(s) on
• Problem(s)
• Organizations Role
• Priorities
• Objectives for the next 24 hours.
• Strategies and tactics to carry out objectives.
• Cost estimate
• Operations, Logistics, Finance/Admin are
  available to clarify questions.
• Agency Executive(s) provide input on overall
  priorities and objectives.

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Planning Meeting Process

• Plans Coordinates meeting. Finalize Plan.
• Command
• Determines the ICS organizationn structure
• Sets the operational period.
• Establishes the overall objectives.
• Approves the IAP.
• Operations
• Identify strategies, resources and assignments to
  carry out the objectives.
• Logistics
• Identify support services needed to carry out
  tactics.
• Finance/Admin
• Determine the cost for the activities in the IAP.

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Incident Reporting ProceduresVA Medical Centers

• Initial Reporting.
• When an incident occurs that requires the
  activation of a VA Facilitys Emergency
  Operations Plan/Incident Command System (ICS),
  the situation is reported using an Issue Brief or
  Situation Report form to the designated contact
  at the VISN office as soon as is reasonable. An
  Operating Status Capability Assessment Report
  (OSCAR) can be attached.

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Incident Reporting ProcedureVA Medical Centers
(cont)

• Subsequent Reporting.
• When emergency situations are not resolved
  within the initial 24 hour period, or as directed
  by the VISN office, VA Facilities should be
  conducting the incident action planning process.
• In addition to the Issue Brief, an Incident
  Action Plan (IAP) will be submitted to the
  designated contact at the VISN office.

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Incident Reporting ProcedureVA Medical Centers
(cont)

• Incident Termination.
• VA Facilities must indicate termination of an
  incident by sending an email to the designated
  contact at the VISN office stating the emergency
  situation has been resolved.
• If Outlook is down, the report should be
  submitted by telephone to the designated VISN
  point-of-contact.

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Incident Reporting ProcedureVISN Offices

• Initial Reporting.
• As soon as reasonable, designated contact(s)
  at the VISN office should review and forward the
  VA Facility Issue Brief/OSCAR to the Outlook mail
  group VHA EMSHG Operations, with the subject
  line ATTN VHA OC Duty Officer.
• If Outlook is down, the report should be
  submitted by telephone using 304-264-4800, and
  then FAXed to 304-264-4499.

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Incident Reporting ProcedureVISN Offices (cont)

• Subsequent Reporting.
• VISN Offices should review and forward
  subsequent VA facility reports or consolidate
  information received from VA facilities into a
  VISN Issue Brief.
• As directed by Central Office, the VISN
  Office should conduct the incident action
  planning process.
• VISN Office reporting should be by Outlook
  email group VHA OC with the subject line ATTN
  VHA OC Duty Officer.

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Incident Reporting ProceduresVISN Offices
(cont)

• Incident Termination.
• VISN offices should send an email indicating
  termination of an incident at a VA Facility to
  the Outlook email group VHA OC with the subject
  line, ATTN VHA OC Duty Officer.
• If Outlook is down, the report should be
  submitted by telephone using 304-264-4800, and
  then FAXed to 304-264-4499.

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Reporting Times

• VAMC Reports
• Issue Brief 0730
• Action Plan 1100
• Issue Brief 1930

VISN Reports Issue Brief 0900 Action
Plan 1300 Issue Brief 2100
All times are local. VHA CO may change reporting
times based on incident requirements.
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Future DirectionsIncident Action Planning
Reporting

• VHA Emergency Operations Procedures are part of
  EMA 3 on the VA LMS and will be the basis of a
  training program beginning in October, 2009.
• 10N and EMSHG are working with the Office of
  Quality Management to establish a web-based
  reporting system.
• The OSCAR will be re-formatted to reflect the
  Capability Assessment Program framework, to
  enable collection of performance data.

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Questions?