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Appendix C: What Is An Incident Action Plan?

Medical Surge Capacity and Capabilities (MSCC) Handbook

An incident action plan (IAP) formally documents incident goals (known as control objectives in NIMS), operational period objectives, and the response strategy defined by incident command during response planning. It contains general tactics to achieve goals and objectives within the overall strategy, while providing important information on event and response parameters. Equally important, the IAP facilitates dissemination of critical information about the status of response assets themselves. Because incident parameters evolve, action plans must be revised on a regular basis (at least once per operational period) to maintain consistent, up-to-date guidance across the system.

The following should be considered for inclusion in an IAP:

  • Incident goals (where the response system wants to be at the end of response)
  • Operational period objectives (major areas that must be addressed in the specified operational period to achieve the goals or control objectives)
  • Response strategies (priorities and the general approach to accomplish the objectives)
  • Response tactics (methods developed by Operations to achieve the objectives)
  • Organization list with ICS chart showing primary roles and relationships
  • Assignment list with specific tasks
  • Critical situation updates and assessments
  • Composite resource status updates
  • Health and safety plan (to prevent responder injury or illness)
  • Communications plan (how functional areas can exchange information)
  • Logistics plan (e.g., procedures to support Operations with equipment, supplies, etc.)
  • Responder medical plan (providing direction for care to responders)
  • Incident map (i.e., map of incident scene)
  • Additional component plans, as indicated by the incident.

What follows is an example of an individual healthcare organization (HCO) action plan, as it might appear following response planning by the HCO incident management team. This is meant only to give the reader a general idea of how the components in the foregoing list might be described in an HCO action plan during emergency response. In reality, the information included in an action plan will vary depending on the incident circumstances and the type of response asset.

Sample Considerations for an HCO Incident Action Plan

Scenario: contagious disease outbreak with limited numbers of patients.

  • HCO goal: to protect the facility, personnel, and non-incident patients from the effects of the hazard (i.e., infectious disease) while providing optimal care to incident victims and maintaining normal medical operations.
  • HCO objectives:
    • Maintain safety of HCO personnel
    • Maintain safety of non-incident patients
    • Provide care to infected, exposed, or concerned patients.
  • HCO strategies and tactics:
    • Activate appropriate assets in the hospital to address general need for increased patient volume (incident management team, emergency department (ED), laboratory personnel, etc.)
    • Establish the operational period for HCO response planning
    • Secure portals of entry into the HCO to monitor for entry of infected/contagious patients
      • Post signs that contain easy-to-understand instructions for potential incident victims to decrease the likelihood of disease transmission.
      • Post security at each entrance (with personal protective equipment (PPE)) to monitor purpose of visit.[92]
      • Brief ED triage personnel and provide them with PPE.
    • Monitor staff for signs/symptoms of illness (services provided by the HCO occupational health staff)
      • Unit leader to perform check at shift change.
    • Provide for infection control
      • Distribute PPE to HCO staff
      • Provide instruction to HCO staff on the use of PPE
      • Provide instruction to staff on procedures that are high risk for transmission of agent.
  • HCO resources assigned:
    • Security personnel (numbers assigned)
    • ED (including staff to augment response in ED)
    • Occupational health personnel (to monitor employee health)
    • Infection control personnel (assisting with instructions and delivery of PPE)
    • Personnel pool staff available to supplement above assignments.
  • HCO event updates:
    • Information relevant to internal facility operations:
      • Number of patients screened and released in ED over the past 24 hours
      • Number of patients admitted with diagnosis of suspected disease
      • Number of patients admitted with confirmed disease (placed in cohort isolation)
      • Information on known patient-to-staff transmission of disease (or lack thereof)
      • Updates on case definition, risk factors for contracting the disease, and other new information.
    • Information relevant to external operations:
      • Number of patients screened in all jurisdictional and regional EDs over the past 24 hours;
      • Number of patients admitted with suspected disease in all jurisdictional and regional EDs
      • Number of patients admitted with confirmed disease in all jurisdictional and regional EDs
      • Number of cases of nosocomial and hospital staff cases of disease in jurisdictional and regional HCOs
      • Description of the Tier 3 response to date (including higher tiers as relevant).
  • Section updates:
    • Incident Command
    • Operations: particular emphasis on staffing
    • Logistics: including emphasis on where and how to obtain PPE and prophylaxis
    • Planning: emphasis on turning in functional area reports by pre-designated times
    • Administration/Finance
  • Safety message:
    • Coordinated with the healthcare coalition (Tier 2) and jurisdictional authorities (Tier 3) to promote a uniform message to HCO personnel in the jurisdiction
    • Covers infection control, PPE, prophylaxis, extended incident stress and other topics.
  • Communications message:
    • Internal: contact method for emergent messages and routine functional area updates.
    • External: provides explanation for the differences in communication channels for strategic issues (contact external agencies through HCO management function) and for tactical issues (direct contact with external responders).
  • Event projections: as available. 

92. This demonstrates the importance of sharing incident action plans that contain general strategies and specific tactics. If one HCO has personnel wearing PPE while other HCOs do not, the staff and the general public will be confused and will potentially lose trust in the incident management at the HCO.

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