Public Health Emergency Preparedness
This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.
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Incident Command Center Zone Module
This module was developed by the Johns Hopkins Evidence-based Practice Center under Contract No. 290-02-0018 from the Agency for Healthcare Research and Quality, Rockville, MD. The content of this module is intended to provide guidance for hospital disaster drill evaluation and should not be construed as representing standards of care or recommendations on how to respond to specific types of disasters. No statement in this module should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.
Note: Circle or check (_) as indicated. Y = Yes; N = No; U = Unclear; NA = Not applicable
Observer: ______________________________________________________________ Date: ____/____/____
Observer title: ___________________________________________________________
Hospital: _______________________________________________________________
Period of time of evaluation: _____________ AM / PM (Circle one)
to _____________ AM / PM (Circle one)
|
Time Points
| Event |
Time |
| C1. Time the drill began: (Circle one) |
_____________ AM / PM / U |
| C2. Time the hospital disaster plan was initiated in this zone: (Circle one) |
_____________ AM / PM / U / Not initiated |
| C5. Time the drill ended in this zone: (Circle one) |
_____________ AM / PM / U |
Comments (if comment refers to a specific item, give the item number):
|
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Zone Description:
|
C6. Draw a picture of the zone setup.
|
| Question |
Response |
C7. Where was this zone located? (Check all that apply) |
a. [ ] Ambulance ramp
b. [ ] Inside the hospital
c. [ ] Parking lot
d. [ ] Street/road
e. [ ] Other (specify):
________________________________ |
C8. Was the boundary for this zone defined? |
Y / N / U |
| C9. If this zone had a defined boundary, how was it defined? (Check all that apply) |
a. [ ] Barricade(s)
b. [ ] Security personnel
c. [ ] Sign(s)
d. [ ] Tape
e. [ ] Vehicle(s)
f. [ ] Wall(s), permanent
g. [ ] Wall(s), temporary
h. [ ] No boundary
i. [ ] Other (specify):
________________________________ |
Comments (if comment refers to a specific item, give the item number):
|
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Personnel
| Question |
Response |
C11. Did someone take charge of this zone? |
Y / N / U |
| C12. If someone took charge of this zone, how many minutes after the drill activities in this zone began did this person take charge? (Check one) |
O < 10 min |
| O 10-29 min |
| O 30-59 min |
| O 1-2 hrs |
| O > 2 hrs |
| O NA |
C13. If someone took charge of this zone,
was it the officially designated person? |
Y / N / U / NA |
C14. How was the person in charge of the zone identified? (Check all that apply) |
a. [ ] Arm band
b. [ ] Hat
c. [ ] Name tag
d. [ ] Verbal statement
e. [ ] Vest
f. [ ] Not identified
g. [ ] Other physical identification (specify): ______________________________________ |
C15. Were the following drill participants identifiable? |
a. Drill evaluators |
Y / N / U / NA |
| b. Drill organizers |
Y / N / U / NA |
| c. Media |
Y / N / U / NA |
| d. Medical personnel |
Y / N / U / NA |
| e. Mock victims |
Y / N / U / NA |
| f. Observers |
Y / N / U / NA |
| g. Security |
Y / N / U / NA |
| Question |
Response |
IC1. Who first took charge of this zone? (name and title) |
______________________________________
______________________________________ |
| IC2. How many minutes after the drill activities in this zone began did the officially designated incident commander arrive? (Check one) |
O < 10 min |
| O 10-29 min |
| O 30-59 min |
| O 1-2 hrs |
| O > 2 hrs |
| O Never arrived |
IC3. Were other members of the incident command center easily identifiable? |
Y / N / U |
Was someone fulfilling the functions of the following roles (within the incident command center or elsewhere) or reporting to the incident command center?
If no one fulfilled a specified function, circle "N" in column "a" and go to the next row.
| Role |
a. Function filled |
b. Comments |
| IC4. Incident Commander |
Y / N / U / NA |
|
| IC5. Public Information Officer (contacts with media and community) |
Y / N / U / NA |
|
| IC6. Liaison Officer (contacts with outside hospitals or agencies) |
Y / N / U / NA |
|
| IC7. Safety and Security Officer |
Y / N / U / NA |
|
| IC8. Logistics Chief (oversees the next 5 areas below) |
Y / N / U / NA |
|
| IC9. Facilities Management Unit Leader (physical plant issues) |
Y / N / U / NA |
|
| IC10. Communications Unit Leader (internal communications, e.g., paging) |
Y / N / U / NA |
|
| IC11. Patient Transportation Unit Leader |
Y / N / U / NA |
|
| IC12. Material/Supply Unit Leader |
Y / N / U / NA |
|
| IC13. Nutritional Supply Unit Leader |
Y / N / U / NA |
|
| IC14. Planning Chief (oversees the next 3 areas below) |
Y / N / U / NA |
|
| IC15. Labor Pool Unit Leader (Ancillary staff) |
Y / N / U / NA |
|
| IC16. Medical Staff Unit Leader |
Y / N / U / NA |
|
| IC17. Nursing Unit Leader |
Y / N / U / NA |
|
| IC18. Finance Chief |
Y / N / U / NA |
|
| IC19. Operations Chief oversees the next 3 areas below |
Y / N / U / NA |
|
| IC20. Medical Care Director (patient care areas and issues) |
Y / N / U / NA |
|
| IC21. Ancillary Services Director
(laboratory, radiology, pharmacy, etc.) |
Y / N / U / NA |
|
| IC22. Human Services Director
(staff and psychological support) |
Y / N / U / NA |
|
IC23. Other (specify):
_________________________________ |
Y / N / U / NA |
|
IC24. Other (specify):
_________________________________ |
Y / N / U / NA |
|
IC25. Other (specify):
_________________________________ |
Y / N / U / NA |
|
Comments (if comment refers to a specific item, give the item number):
|
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Zone Operations
| Question |
Response |
C23. When was the location
of this zone determined? (Check one) |
O Determined before the drill |
| O Determined during the drill |
C24. Was the hospital disaster plan available? |
Y / N / U |
C25. If the hospital disaster
plan was available, what was its format? (Check all that apply) |
a. [ ] Complete manual
b. [ ] Flow diagram
c. [ ] Job action sheets
d. [ ] No disaster plan
e. [ ] Other (specify):
________________________________ |
C26. If the hospital disaster
plan was available, how was it accessed? (Check all that apply) |
a. [ ] Computer/Internet
b. [ ] Paper
c. [ ] Personal data assistant (PDA)
d. [ ] Not accessed
e. [ ] Other (specify):
________________________________ |
C27. Was there a biological incident component
to the hospital disaster plan? |
Y / N / U |
| C28. Was there a radiation incident component
to the hospital disaster plan? |
Y / N / U |
C29. Was the space allocated for the zone
adequate? |
Y / N / U |
C30. If not enough space for
the zone, where did zone activities overflow to? (Check all that apply) |
a. [ ] Adequate space allotted
b. [ ] Conference room
c. [ ] Hallways
d. [ ] Outside hospital
e. [ ] Treatment/victim care areas
f. [ ] Waiting rooms
g. [ ] No overflow
h. [ ] NA
i. [ ] Other (specify):
________________________________ |
C31. Was this zone used for the same functions
during non-drill operations? |
Y / N / U |
C32. If this zone was not
used for the same functions in non-drill operations, what was it usually
used for? (Check all that apply) |
a. [ ] Ambulance ramp
b. [ ] Conference room
c. [ ] Hallway
d. [ ] Lobby
e. [ ] Treatment, emergency
f. [ ] Treatment, non-emergency
g. [ ] Triage
h. [ ] Unused
i. [ ] Waiting room
j. [ ] Other (specify):
________________________________ |
IC26. How was the incident
command center configured? (Check one) |
O One room |
| O Two or more contiguous rooms |
| O Two or more non-contiguous rooms |
O Other (specify):
____________________________________ |
IC27. Approximate number of
people in the incident command center. (Check one) |
O < 5 |
| O 6 - 10 |
| O 11 - 20 |
| O > 20 |
IC28. Did the noise level in the incident
command center interfere with effective communication? |
Y / N / U |
| IC29. If the noise level interfered with
communications, were steps taken to correct the problem? |
Y / N / U / NA |
Comments (if comment refers to a specific item, give the item number):
|
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Communications
If device not present, circle "N" in column "a" and go to the next line.
| Communication Device(s) |
a. Was device present? |
b. If present, # available |
c. If present, was it used in drill? |
d. Comments (note problems) |
| Phone |
| C36. 2-way radio/phone(s) |
Y / N / U |
|
Y / N / U |
|
| C37. Direct line(s) |
Y / N / U |
|
Y / N / U |
|
| C38. Landline phone(s) |
Y / N / U |
|
Y / N / U |
|
| C39. Wireless/cell phone(s) |
Y / N / U |
|
Y / N / U |
|
| Radio and Television |
| C40. AM/FM radio(s) |
Y / N / U |
|
Y / N / U |
|
| C41. Television(s) |
Y / N / U |
|
Y / N / U |
|
| Pager |
| C42. Numeric paging |
Y / N / U |
|
Y / N / U |
|
| C43. Overhead paging |
Y / N / U |
|
Y / N / U |
|
| C44. Text paging |
Y / N / U |
|
Y / N / U |
|
| Other Electronic Device |
| C45. E-mail & Internet
access |
Y / N / U |
|
Y / N / U |
|
| C46. FAX machine(s) |
Y / N / U |
|
Y / N / U |
|
| Voice or Physical Communication Device |
| C47. Intercom |
Y / N / U |
|
Y / N / U |
|
| C48. Megaphone(s) |
Y / N / U |
|
Y / N / U |
|
| C49. Runner(s) |
Y / N / U |
|
Y / N / U |
|
| Other (Specify) |
| C50. ______________________ |
Y / N / U |
|
Y / N / U |
|
| C51. ______________________ |
Y / N / U |
|
Y / N / U |
|
| C52. ______________________ |
Y / N / U |
|
Y / N / U |
|
| Question |
Response |
| C53. How was incoming information
to the zone recorded? (Check all that apply) |
a. [ ] Computer (other electronic device)
b. [ ] Notepaper
c. [ ] Posted paper
d. [ ] White board/chalk board
e. [ ] Not recorded
f. [ ] Other (specify):
________________________________ |
Comments (if comment refers to a specific item, give the item number):
|
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Information Flow
| Question |
Response |
C54. How was this zone notified
of the event? (Check all that apply) |
a. [ ] FAX
b. [ ] Runner
c. [ ] Telephone
d. [ ] Not notified
e. [ ] Other (specify):
________________________________ |
C55. Who notified this zone
of the event? (Check all that apply) |
a. [ ] Drill organizer
b. [ ] Incident command center
c. [ ] Media
d. [ ] Other hospital staff
e. [ ] Outside source
f. [ ] Victims arriving
g. [ ] Not notified
h. [ ] Other (specify):
________________________________
|
C59. Were problems created by delays in
receiving information? (If problems were created by delays in information, specify
in comment box at end of this section.) |
Y / N / U |
How often was the following information received by the incident
command center?
If this information was not received, circle "NA"
and go to the next row.
| Information |
Circle approximately how often |
| IC30. Available operating
rooms |
once / multiple updates / U / NA |
| IC31. Available staffed floor
beds |
once / multiple updates / U / NA |
| IC32. Available staffed intensive
care beds
| once / multiple updates / U / NA |
| IC33. Available staffed isolation
beds |
once / multiple updates / U / NA |
| IC34. Number of arriving victims |
once / multiple updates / U / NA |
| IC35. Estimated time window
of victims' arrival |
once / multiple updates / U / NA |
| IC36. Expected triage level
of victims |
once / multiple updates / U / NA |
| IC37. Number of victims Emergency
Department can accept |
once / multiple updates / U / NA |
| IC38. Clinical staff available
(e.g., physicians, nurses) |
once / multiple updates / U / NA |
| IC39. Total number of expected
victims |
once / multiple updates / U / NA |
| IC40. Potential discharges
of 'actual' patients |
once / multiple updates / U / NA |
| IC41. Support staff available
(e.g., registrar, security) |
once / multiple updates / U / NA |
IC42. Other (specify):
________________________________ |
once / multiple updates / U / NA |
IC43. Other (specify):
________________________________ |
once / multiple updates / U / NA |
IC44. Other (specify):
________________________________ |
once / multiple updates / U / NA |
| Question |
Response |
IC45. What means did the incident
command center use to receive data from within the hospital? (Check all that apply) |
a. [ ] 2-way radio/phone
b. [ ] Cell phone
c. [ ] Computer
d. [ ] FAX
e. [ ] Landline phone
f. [ ] Pager
g. [ ] Runners
h. [ ] No data received
i. [ ] Other (specify):
________________________________ |
IC46. Did the hospital activate a memorandum
of understanding (MOU) with any external agency regarding use of services
or resources? (If MOU was activated, specify in comment box at end of this section.) |
Y / N / U / NA |
Was the incident command center in communication with outside agencies?
(Check all that apply)
If not in communication with outside agencies, circle
"N" in column "a" and go to the next row.
| Outside Agencies |
a. Contacted |
b. Note any issues with communication |
| IC47. Ambulance systems |
Y / N / U / NA |
|
| IC48. Disaster response agency
(State or Federal) (e.g., FEMA) |
Y / N / U / NA |
|
| IC49. Fire |
Y / N / U / NA |
|
| IC50. Health department (local,
State, or Federal) |
Y / N / U / NA |
|
| IC51. Media |
Y / N / U / NA |
|
| IC52. Military |
Y / N / U / NA |
|
| IC53. Other hospitals |
Y / N / U / NA |
|
| IC54. Police |
Y / N / U / NA |
|
IC55. Other (specify):
_____________________________________ |
Y / N / U / NA | |
IC56. Other (specify):
_____________________________________ |
Y / N / U / NA | |
| Question |
Response |
IC57. What means did the incident
command center use to receive data from outside of the hospital? (Check all that apply) |
a. [ ] 2-way radio/phone
b. [ ] Cell phone
c. [ ] Computer
d. [ ] FAX
e. [ ] Landline phone
f. [ ] Pager
g. [ ] Runners
h. [ ] No data received
i. [ ] Other (specify):
________________________________ |
Comments (if comment refers to a specific item, give the item number):
|
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Security
| Question |
Response |
C60. Were security personnel present in
this zone? |
Y / N / U |
| C61. If security were needed but not present,
how were they contacted? (Check all that apply) |
a. [ ] 2-way radio/phone
b. [ ] Overhead pager
c. [ ] No security present
d. [ ] Other (specify):
________________________________ |
C62. If security personnel
were present, what type of security? (Check all
that apply and provide approximate numbers) |
a. [ ] FBI: ________________ |
| b. [ ] Hospital security: ___________ |
| c. [ ] Local police: __________ |
| d. [ ] State police: _______________ |
| e. [ ] NA |
f. [ ] Other (specify):
________________________________
|
C63. Did all security staff present have
a portable means of communication? |
Y / N / U / NA |
| C64. Were entrances and exits
strictly controlled in this area? |
Y / N / U / NA |
Did any of the following security issues arise in this zone?
If the security issue did not arise, circle "N"
in column "a" and go to the next row.
| Security Issue |
a. Arose? |
b. If yes, did security respond? |
c. If yes, was order maintained? |
d. Description of issue and measures taken |
| C65. Access in and out |
Y / N / U |
Y / N / U |
Y / N / U |
|
| C66. Assistance for family
members |
Y / N / U |
Y / N / U |
Y / N / U |
|
| C67. Assistance lifting supplies
or victims |
Y / N / U |
Y / N / U |
Y / N / U |
|
| C68. Crowd control |
Y / N / U |
Y / N / U |
Y / N / U |
|
| C69. Media control |
Y / N / U |
Y / N / U |
Y / N / U |
|
| C70. Transportation/ traffic
control |
Y / N / U |
Y / N / U |
Y / N / U |
|
| C71. Unruly victims |
Y / N / U |
Y / N / U |
Y / N / U |
|
C72. Other (specify):
________________________________ |
Y / N / U |
Y / N / U |
Y / N / U |
|
C73. Other (specify):
________________________________ |
Y / N / U |
Y / N / U |
Y / N / U |
|
Comments (if comment refers to a specific item, give the item number):
|
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Victim Documentation and Tracking
There are no items for this section in the incident
command center zone module.
Victim Flow
There are no items for this section in the incident
command center zone module.
Personal Protective Equipment (PPE) and Safety
There are no items for this section in the incident
command center zone module.
Equipment and Supplies
There are no items for this section in the incident
command center zone module.
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Rotation of Staff
| Question |
Response |
C98. Was there a staff rotation/shift
change? |
Y / N / U |
| C99. If there was a staff rotation, did
the officially designated person in charge of the zone change? |
Y / N / U / NA |
C100. If there was a staff rotation, did
problems arise? (If problems arose, explain in comments box at the end of this
section.) |
Y / N / U / NA |
C101. What method of shift
changing was used? (Check one) |
O Group shift change |
| O Staggered shift change |
| O NA |
O Other (specify):
________________________________ |
C102. How were incoming staff
updated? (Check all that apply) |
a. [ ] Group briefing
b. [ ] Individual briefing
c. [ ] Written notes
d. [ ] Not updated
e. [ ] NA
f. [ ] Other (specify):
________________________________ |
Comments (if comment refers to a specific item, give the item number):
|
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Zone Disruption
| Question |
Response |
C103. Was there a plan in place to relocate
this zone if necessary? |
Y / N / U |
| C104. Did this zone close at any time
during the drill? If no, disregard the remainder of this
section. STOP. This zone module is complete. |
Y / N / U |
C105. If the zone closed during
the drill, what was the reason for closing? (Check all that apply) |
a. [ ] Contamination
b. [ ] Other safety concerns
c. [ ] Space
d. [ ] Other (specify):
________________________________ |
C107. If the zone closed during the drill,
were other zones notified? |
Y / N / U |
| C108. If the zone closed during the drill,
did it reopen in the same location? |
Y / N / U |
If the zone did reopen in the same location: |
| C109. Were operations interrupted until
this zone reopened? |
Y / N / U / NA |
C111. Were other zones notified when this
zone reopened? |
Y / N / U / NA |
| C112. Were any critical issues observed
with reopening this zone? (If critical issues were observed, explain in the comments
box at the end of this section.) |
Y / N / U / NA |
| C113. If the zone did NOT reopen in the
same location, was an alternate site opened? |
Y / N / U / NA |
If the zone reopened in an alternate site: |
| C114. Where did the zone reopen?
(specify): ____________________________________________________________ |
| C115. Did the initial zone close before
the new zone opened? |
Y / N / U / NA |
| C116. Were operations interrupted until
this zone reopened? |
Y / N / U / NA |
| C117. Was the incident command center
notified of this zone's relocation? |
Y / N / U / NA |
| C118. Were other zones notified of this
zone's relocation? |
Y / N / U / NA |
| C119. Were portable means of communication
used while relocating this zone? |
Y / N / U / NA |
| C120. Were any critical issues observed
with this relocation? (If critical issues were observed, explain in the comments
box at the end of this section.) |
Y / N / U / NA |
Comments (if comment refers to a specific item, give the item number):
|
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