Page 1 of 1 ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.) ICS – ACTION STEP SERIES SYNOPSIS The ICS – Action Step Series is a principally based, comprehensive, step-by-step guide for healthcare professionals who are responding to an armed violent intruder in the hospital; and are involved in the initial activation stages of the Incident Command. The ICS – Action Step Series is specifically designed to supplement the Hospital Incident Command System (HICS) and to facilitate an enhanced, deliberate ICS response to the dynamic, unforgiving circumstances of an armed violent intruder. Mitigation Dynamics, Inc. (MDI) has provided various training and consultation to thousands of healthcare professionals throughout the United States. One of MDI’s hospital incident command curriculums entitled, Incident Command Activation Response Training (I.C.A.R.T.) , utilizes scenario based training designed to mirror the dynamic circumstances of an armed violent intruder; and how incident command staff should consider responding. After facilitating numerous scenario based exercises, MDI recognized the critical need to create a supplement to the existing HICS structure in order to effectively manage the hospital response to an armed violent intruder. MDI staff conducted a collective review of the I.C.A.R.T. training data and identified a series of objectives that were critical to an effective ICS response. As a result, MDI utilized their collective “real world” critical incident problem solving experience, combined with information obtained from extensive debriefs of critical incidents throughout the world, and created the Armed Violent Intruder Response (A.V.I.R.) ICS – Action Step Series . The spirit of the ICS – Action Step Series is to work in conjunction with HICS and therefore is designed in a format consistent with Job Action Sheets. The action steps are listed sequentially throughout this packet and are strongly suggested for healthcare ICS staff to consider for implementation in response to an armed violent intruder. Principally, the Action Step Series mirrors HICS, however there are elements that do not exactly match; ultimately the result of creating efficient action step priorities and communication. The most notable enhancement is the implementation of an additional Section Chief (Security), which was moved from the Operations Section to streamline communication when responding to the dynamic nature of an armed violent intruder, see attached Organizational Chart. FACT: The actions of an armed violent intruder (active shooter) create a dynamic, unpredictable environment that has a high propensity for multiple people to be critically injured or killed in a very small amount of time. In addition, departments throughout the hospital will be immediately affected and/or compromised, ultimately challenging quality patient care objectives as well as the general safety for patients, visitors, physicians and staff. Therefore it is critical that the staff in the Hospital Command Center respond accordingly, and consider the utilization of the ICS – Action Step Series.
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Page 1 of 1
ARMED VIOLENT INTRUDER RESPONSE (A.V.I.R.)
ICS – ACTION STEP SERIES
SYNOPSIS
The ICS – Action Step Series is a principally based, comprehensive, step-by-step guide for healthcare professionals who
are responding to an armed violent intruder in the hospital; and are involved in the initial activation stages of the Incident
Command. The ICS – Action Step Series is specifically designed to supplement the Hospital Incident Command System
(HICS) and to facilitate an enhanced, deliberate ICS response to the dynamic, unforgiving circumstances of an armed
violent intruder.
Mitigation Dynamics, Inc. (MDI) has provided various training and consultation to thousands of healthcare professionals
throughout the United States. One of MDI’s hospital incident command curriculums entitled, Incident Command
Activation Response Training (I.C.A.R.T.), utilizes scenario based training designed to mirror the dynamic circumstances
of an armed violent intruder; and how incident command staff should consider responding. After facilitating numerous
scenario based exercises, MDI recognized the critical need to create a supplement to the existing HICS structure in order
to effectively manage the hospital response to an armed violent intruder.
MDI staff conducted a collective review of the I.C.A.R.T. training data and identified a series of objectives that were
critical to an effective ICS response. As a result, MDI utilized their collective “real world” critical incident problem
solving experience, combined with information obtained from extensive debriefs of critical incidents throughout the
world, and created the Armed Violent Intruder Response (A.V.I.R.) ICS – Action Step Series.
The spirit of the ICS – Action Step Series is to work in conjunction with HICS and therefore is designed in a format
consistent with Job Action Sheets. The action steps are listed sequentially throughout this packet and are strongly
suggested for healthcare ICS staff to consider for implementation in response to an armed violent intruder. Principally,
the Action Step Series mirrors HICS, however there are elements that do not exactly match; ultimately the result of
creating efficient action step priorities and communication. The most notable enhancement is the implementation of an
additional Section Chief (Security), which was moved from the Operations Section to streamline communication when
responding to the dynamic nature of an armed violent intruder, see attached Organizational Chart.
FACT: The actions of an armed violent intruder (active shooter) create a dynamic, unpredictable environment that has a
high propensity for multiple people to be critically injured or killed in a very small amount of time. In addition,
departments throughout the hospital will be immediately affected and/or compromised, ultimately challenging quality
patient care objectives as well as the general safety for patients, visitors, physicians and staff. Therefore it is critical that
the staff in the Hospital Command Center respond accordingly, and consider the utilization of the ICS – Action Step
Series.
Incident Commander
Public
Information
Officer
Liaison Officer
Safety Officer
Operations
Section Chief
Planning Section
Chief
Security Section
Chief
Logistics Section
Chief
Financial
Administration
Section Chief
Position
Activated
LEGEND:
Medical Care
Branch Director
Staging Manager
HazMat Branch
Director
Infrastructure
Branch Director
Inpatient Care Leader
Casualty Care Leader
Outpatient Care Leader
Patient Registration Unit Leader
Personnel Staging Team Leader
Equipment Supply Staging
Team Leader
Medication Staging Team
Leader
Power / Lighting Unit Leader
Med Gases Unit Leader
Water / Sewer Unit Leader
Detection and Monitoring Unit Leader
Victim Decontamination Unit Leader
Spill Response Unit Leader
Facility / Equipment Decontamination
Unit Leader
Security Branch
Director
Law
Enforcement
Interface Unit
Leader
Access Control Unit Leader
Crowd Control Unit Leader
Traffic Control Unit Leader
Search Unit Leader
Situation Unit
Leader
Resources Unit
Leader
Documentation
Unit Leader
Demobilization
Unit Leader
Patient Tracking Manager
Bed Tracking Manager
Personnel Tracking
Manager
Material Tracking Manager
Support Branch
Manager
Service Branch
Manager
Supply Unit Leader
Facilities Unit Leader
Family Care Unit Leader
Transportation Unit
Leader
Labor Pool Credentialing
Unit Leader
Employee Health and Well
Being Unit Leader
Communications Unit
Leader
IT / IS Unit Leader
Time Unit Leader
Procurement
Unit Leader
Compensation
Claims Unit
Leader
Cost Unit Leader
Security Liaison Officer
Medical /
Technical
Specialist
ICS – ACTION STEP SERIES
Organizational Chart
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INCIDENT COMMANDER (IC) (Administrator on Call / Nursing Supervisor)
ACTION STEPS
Assume command / notify others "I am the Incident Commander"
* Self initiate Incident Command System (ICS) Action Steps, ASAP
* During scenario based drills & "real world" critical incidents, this BASIC, yet KEY step is overlooked
Ensure appropriate hospital Element of Performance (EOP) has been activated (Code Silver, etc.)
Select Command Center (CC) and have contingency location should primary location be compromised
Ensure hospital ICS staff notification has been implemented
Ensure all other ICS staff are informed of selected CC location
Ensure all ICS staff are informed of who is the Incident Commander (IC)
Ensure ONLY those REQUIRED are present in CC (control the number of participants)
Provide an initial briefing to all ICS staff present
Utilize what information is available at the time and act accordingly
Caution: It will not be practical to verify information during an AVIR
Identify and assign Section Chiefs in the following order:
Operations
Security
Security Chief streamlines communication during an A.V.I.R. (See Organizational Chart)
Logistics
Planning
Finance
Establish & Disseminate Primary Objectives / All SECTION CHIEFS:
Continue quality patient care
Ensure safety of patients, visitors, physicians and staff
Provide triage and treatment of those injured in incident
AR
MED
VIO
LENT IN
TRU
DER
RESP
ON
SE ICS-A
CTIO
N STEP
SERIES
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Maintain relevant span of control
Communicate critical information to ICS staff and Section Chiefs in a timely manner