All-Hazards Approach to Disasters

Clinicians Course/ Version 1

07 April 2009
SECTION I. ADMINISTRATIVE DATA

All Courses Course Number Version Course Title

Including This
Lesson

Task(s) Task Number Task Title

Taught(*) or
Supported

Reinforced Task Number Task Title

Task(s)

Academic The academic hours required to teach this lesson are as follows:
Hours
Resident
Hours/Methods
20mins / Conference / Discussion
mins / Conference/Demonstration
mins / Conference/Demonstration
hrs / Practical Exercise (Performance)
Test 0 hrs
Test Review 0 hrs

Total Hours:

Test Lesson Hours Lesson No.

Number
Testing
(to include test review) N/A

Prerequisite Lesson Number Lesson Title

Lesson(s) PNCBRNE1 Introduction to CBRNE

Clearance Security Level: Unclassified

Access Requirements: There are no clearance or access requirements for the lesson.

Foreign FD5. This product/publication has been reviewed by the product developers in
Disclosure coordination with the USAMEDDC&S foreign disclosure authority. This product is
Restrictions releasable to students from all requesting foreign countries without restrictions.

References Number Title Date Additional

Information
JP 3-26 Joint Publication, 2005
Homeland Security
NRP National Response Plan 2004 FEMA
NIMS IS-700 National Incident 2004 FEMA
Management System
ERG2004 Emergency Response 2004
Guidebook

Student Study None

D-1
Assignments

Instructor One instructor, 1301 or 1712 Civ (CBRNE/NBC), 74D2/30, 74A- ITC qualified
Requirements

Additional Name Stu Qty Man Hours

Support Ratio
Personnel None
Requirements
Equipment Id Stu Instr Spt Qty Exp
Required Name Ratio Ratio
COMPUTER-INSTRUCTOR No 1 No
COMPUTER (CPU) WITH KEYBOARD,
INSTRUCTOR USE ONLY
MONITOR-INSTRUCTOR No 1 No
COMPUTER MONITOR
PROJECTOR-INSTRUCTOR No 1 No
OVERHEAD PROJECTOR WITH COMPUTER
INTERFACE
SCREEN-INSTRUCTOR No 1 No
SCREEN PROJECTOR, INSTRUCTOR USE
* Before Id indicates a TADSS

Materials Instructor Materials:

Required PN1Z0000 Power point presentation and lesson plan.

Student Materials:
Duty Uniform, student handouts, pen/pencil, paper

Classroom,
Training Area,
and Range
Requirements LEVEL ONE, GENERAL PURPOSE CLASSROOM, 20 PN

Ammunition Exp Stu Instr Spt

Requirements Id Name Ratio Ratio Qty
None
Instructional NOTE: Before presenting this lesson, instructors must thoroughly prepare by studying this
Guidance lesson and identified reference material.
Ensure the classroom is open, computer, power point presentation, and projector
work at least 15 minutes prior to the class.

Proponent Name Rank Position Date

Lesson Plan
Approvals CBRNE SCI BR, PN

D-2
SECTION II. INTRODUCTION

Method of Instruction: Conference/Lecture

Instructor to Student Ratio is: 1:20
Time of Instruction: 4 min
Media: Large Group Instruction

Motivator

Terminal NOTE: Inform the students of the following Terminal Learning Objective requirements.
Learning
Objective At the completion of this lesson, you [the student] will:

Discuss the concept of an “all-hazards” approach so that

Action:
responders can effectively prepare and respond to an all-hazards
incident.

Conditions: NONE

Standards: IAW JP 3-26, National Response Plan (NRP), NIMS IS-700 (National
Incident Management System), Emergency Response Guidebook
2004.

Safety None
Requirements

Risk Low
Assessment
Level

Environmental NOTE: It is the responsibility of all Soldiers and DA civilians to protect the environment from
Considerations damage.
none

Evaluation Students will be evaluated using a written test. Students must score a minimum of
70% to receive a GO!
Instructional
Lead-In

D-3
SECTION III. PRESENTATION

A. ENABLING LEARNING OBJECTIVE A

ACTION: Identify the principals of "all-hazards“ and "all-hazards

preparedness“
CONDITIONS: NONE
STANDARDS: IAW JP 3-26, National Response Plan (NRP), NIMS IS-700 (National
Incident Management System), Emergency Response Guidebook
2004.

1. Learning Step / Activity 1. Principals of "all-hazards“ and "all-hazards preparedness“

Method of Instruction: Conference / Lecture
Instructor to Student Ratio: 1:20
Time of Instruction: 10 min
Media: Large Group Instruction

NOTE: Show Slide 1 thru 5

All-Hazards Approach to Disasters

All-Hazards Preparedness

Recent high profile terrorist attacks, accidents, and natural disasters have reinforced the need for disaster
preparedness across a wide range of potential threats. The United States is now more prepared than
ever before to respond to disasters and mount an effective emergency response.

There is an ever present potential for disaster to strike and overwhelm emergency services.

Discuss the concept of an “all-hazards” approach so that responders can effectively prepare and respond
to an all-hazards incident.

• Identify the principals of "all-hazards“ and "all-hazards preparedness“

• Explain how an "all-hazards" approach affects preparedness

Homeland Security Presidential Directive-8

Establishes policies to strengthen the preparedness of the United States to prevent and respond to
threatened or actual domestic terrorist attacks, major disasters, and other emergencies by requiring a
national domestic all-hazards preparedness goal, establishing mechanisms for improved delivery of
Federal preparedness assistance to State and local governments, and outlining actions to strengthen
preparedness capabilities of Federal, State and local entities.

“All-Hazards” Preparedness

D-4
NOTE: The term "all-hazards preparedness" is the comprehensive preparedness required to manage
the casualties resulting from the host of possible hazards. Describes various man-made and natural
events that have the capacity to cause multiple casualties.
NOTE: The "all-hazards" approach is unique and far reaching. Eliminates critical seams and ties
together a complete spectrum of incident management activities. Allows communities to increase the
speed, effectiveness, and efficiency of incident management.

Hazard Identification (Show Slide 6 thru 8)

It is crucial for communities to identify the potential hazards that could affect the area that they live.

All hazards are categorized as:

● Natural
● Man-made: technological
● Man-made: terrorism

NOTE: Disasters, whether natural or man-made, can have substantial and long lasting consequences
that adversely affect the community.

NOTE: A hazard can cause the full range of natural disasters, major man-made incidents, and resource
crises that become the concern of the entire community.

Natural Hazards

● Volcanoes
● Tornados
● Hurricanes
● Floods
● Wildfires
● Earthquakes
● Tsunamis

NOTE: Natural hazards are natural events that threaten lives, property, and assets. Often natural
hazards can be predicted. They tend to occur repeatedly in the same geographical locations because
they are related to weather patterns or physical characteristics of an area.

Man-Made: Accidental & Technological Hazards

● Hazardous materials incidents

● Nuclear power plant failures
● Fire

NOTE: Usually, little or no warning precedes incidents involving technological hazards. In many cases,
victims may not know they have been affected until many years later. For example, the Ammonia plant
accident in Bhopal, India that is still affecting the health of the local residents today.

NOTE: The number of technological incidents is escalating, mainly as a result of increased number of
new substances and the opportunities for human error inherent in the use of these materials.

NOTE: Hazardous materials in various forms can cause death, serious injury, long-lasting health effects,
and damage to buildings, homes, and other property.

• Many products containing hazard materials are used and stored in homes routinely.

D-5
 •Various materials and products are shipped daily on the nation's highways, railways,
waterways, and pipelines.
• Come in the form of explosives, flammable and combustible substances, poisons, and
radioactive materials.
NOTE: Nuclear Power:

• Major hazards to people in the vicinity of the plume are radiation exposure to the body
from the cloud and particles deposited on the ground, inhalation of radioactive materials,
and ingestion of radioactive materials.

NOTE: At fixed facilities there is likely to be a window of time before the release of radiation starts, as
opposed to an improvised nuclear device (IND) or a nuclear bomb, which may be initiated without any
advanced warning.

• Operated in most states in the country and produce about 20% of the nation's power.
• Potential danger from an accident at a nuclear power plant is exposure to radiation.

NOTE: Fire:

• Each year, more than 4,000 Americans die and more than 25,000 are injured in fires,
many of which could be prevented.
• Direct property loss due to fires is estimated at $8.6 billion annually.
• Heat and smoke from fire can be more dangerous than the flames.

Man-Made: Terrorism (Show Slide 9)

Some recent examples include:

● Madrid train bombings

● London bombings

● World Trade Center/Pentagon

● Tokyo subway nerve agent attack

● Oklahoma City bombing

NOTE: The threat of terrorism is real. Terrorists have the knowledge and the capability to strike
anywhere in the world. We have seen that when properly motivated, terrorists will do whatever they have
to do in order to achieve their goals.

Terrorism will be discussed in more detail later in the course.

Check on learning:

Question: What type of hazard tends to occur repeatedly in the same geographical locations because
they are related to weather patterns or physical characteristics of an area?

Answer: Natural Hazards

D-6
B. ENABLING LEARNING OBJECTIVE B

ACTION: Explain how an "all-hazards" approach affects preparedness

CONDITIONS: NONE
STANDARDS: IAW JP 3-26, National Response Plan (NRP), NIMS IS-700 (National
Incident Management System), Emergency Response Guidebook
2004.
2. Learning Step / Activity 2. How an "all-hazards" approach affects preparedness
Method of Instruction: Conference / Lecture
Instructor to Student Ratio: 1:20
Time of Instruction: 10 min
Media: Large Group Instruction

NOTE: Show Slide 10 thru 12

Homeland Security Presidential Directive-5

HSPD-5 requires all Federal departments and agencies to:

• Adopt NIMS and use it in their individual incident management programs and activities.

• Make adoption of NIMS by State, tribal, and local organizations a condition for Federal
preparedness assistance.

Phases of Effective Response:

NOTE: Preparedness: A continuous cycle of planning, organizing, training, equipping, exercising,

evaluating, and taking corrective action in an effort to ensure effective coordination during incident
response. Within the National Incident Management System, preparedness focuses on the following
elements: planning; procedures and protocols; training and exercises; personnel qualification and
certification; and equipment certification.

D-7
NOTE: Response: Activities that address the short-term, direct effects of an incident. Response
includes immediate actions to save lives, protect property, and meet basic human needs. Response also
includes the execution of emergency operations plans and of mitigation activities designed to limit the
loss of life, personal injury, property damage, and other unfavorable outcomes. As indicated by the
situation, response activities include applying intelligence and other information to lessen the effects or
consequences of an incident; increased security operations; continuing investigations into nature and
source of the threat; ongoing public health and agricultural surveillance and testing processes;
immunizations, isolation, or quarantine; and specific law enforcement operations aimed at preempting,
interdicting, or disrupting illegal activity, and apprehending actual perpetrators and bringing them to
justice.
NOTE: Recovery: The development, coordination, and execution of service- and site-restoration plans;
the reconstitution of government operations and services; individual, private-sector, nongovernmental,
and public assistance programs to provide housing and to promote restoration; long-term care and
treatment of affected persons; additional measures for social, political, environmental, and economic
restoration; evaluation of the incident to identify lessons learned; post-incident reporting; and
development of initiatives to mitigate the effects of future incidents.

Incident Command System

NOTE: The Incident Command System (ICS) is a widely used and accepted tool for command, control,
and coordination for a response to a disaster and provides a means to coordinate the efforts of individual
agencies as they work toward the common goal of stabilizing an all hazards event. ICS has proven
effective to enhance efficiency in emergency response situations.

NOTE: Show Slide 13 and 14

Hospital Incident Command System (HICS)

HICS may be activated to respond to many types of incidents, including:

● Hazardous Materials (HAZMAT)

● CBRNE
● Planned events such as celebrations, parades, concerts, official visits, etc.
● Natural hazards such as fires
● Law enforcement incidents
● Incidents involving multiple casualties
● Multi-jurisdictional and multi-agency incidents
● Air, rail, water, or ground transportation accidents
● Wide-area search and rescue missions

HICS (Hospital Incident Command System) is a specialized type of ICS used within many medical
facilities within the United States. It is a tool within the Emergency Management Plan that is used to
provide a logical management structure, defined responsibilities, and clear reporting channels for
responding to an emergency.

D-8
 Characteristics of HICS

As with ICS, several important characteristics enhance the effectiveness of HICS:

● Common terminology
● Expandable modular organization
● Consolidated Incident Action Plans (IAPs)
● Integrated communications
● Limiting the control of individuals to a manageable level (3 to 5)
● Designated incident facilities
● Comprehensive resource management

Sections of HICS: (Show Slide 15)

NOTE: The HICS plan is flexible. Only those sections that are needed should be activated. The HICS
plan allows for the addition of needed sections as well as the deactivating of sections at any time. This
promotes efficiency and cost effectiveness.

• Incident Commander: Directs the command, control and coordination functions. Responsibilities
include the coordination of security, emergency, engineering, public relations, operating rooms,
and intensive care.

• Public Information Officer: Provides information to the media. Communicates with IC and
Medical Staff Officer.

• Medical Staff Officer: Organizes, priorities, and assigns physicians to areas where medical care
is being delivered, and advises IC on issues related to the medical staff. Communicates with IC
and Public Information Officer.

• Safety and Security Officer: Monitors and has authority over the safety of rescue operations
and hazardous conditions. Organizes and reinforces scene/facility protection and traffic,
establishes a security command post. Communicates with IC and Liaison.

• Liaison: Functions as the incident contact person for representatives from other agencies.
Communicates with IC and Safety Security Officer.

• Logistics Chief: Responsible for providing facilities, services, and materials, including personnel
to operate the requested equipment for the incident. This section takes on great significance in
long-term or extended operations. Communicates with IC.

D-9
 • Planning Chief: Includes collection, evaluation, dissemination, and use of information about the
development of the incident and the status of the resources. Communicates with IC.

• Finance Chief: Critical for tracking incident costs and reimbursement accounting. Records must
be impeccable to avoid difficulty with reimbursement. This is especially important when the
incident is of a magnitude that may result in a Presidential declaration. Communicates with IC.

• Operations Chief: Responsible for carrying out the response activities described in the
Emergency Response Plan. Communicates with IC.

NOTE: Show Slide 16 thru 20

Job Action Sheets (JASs)

• Are prioritized activity checklists

• One per HICS position
• Always state the following:

¾ Mission statement for the position

¾ Actions to be taken

NOTE: If HICS is activated, personnel should refer to the job action sheets (JASs) immediately for
response actions.

Example Actions:

● Receive appointment from Nursing Unit Leader.

● Read this entire Job Action Sheet & review organizational chart on back.
● Put on position identification vest.
● Obtain a briefing from Nursing Unit Leader.
● Obtain patient census from Nursing Unit Leader, Admitting personnel, or other source.

Activation of HICS

1. Supervisor on duty determines that day-to-day activities of the medical facility are disrupted.
2. Supervisor activates Emergency Management Plan and appropriate HICS sections.
3. Personnel activated attend disaster briefing at the medical facility Emergency Operations
Command (EOC). Incident Commander (IC) assigns section chiefs to perform different functions
at the incident.

NOTE: The purpose behind assigning sections is to divide the incident into smaller, more manageable
units.

In the event that your position is activated as part of the HICS, your role, might include:

● Attend disaster briefing at the medical facility EOC or report to the pre-designated muster area.
● Refer to JAS for response duties.
● Take action.

Additional Training Available

• ICS-100 HC: Introduction to the Incident Command System for Healthcare/Hospital

• ICS-200 HC: Applying ICS to Healthcare Organizations
• ICS-700a:National Incident Management System (NIMS), An Introduction
• ICS-800b: National Response Framework

D-10
 • Hospital Incident Command System (HICS)

Check on learning:

Question: Who directs the command, control and coordination functions?

Answer: Incident Commander

SECTION IV.SUMMARY

Method of Instruction: Conference/Lecture

Instructor to Student Ratio is: 1:20
Time of Instruction: 6 min
Media: Large Group Instruction

Review / A. Review of Main Points

Summarize
Lesson • Identify the principals of "all-hazards“ and "all-hazards preparedness“

• Explain how an "all-hazards" approach affects preparedness

B. Closing Statement:

HICS is a tool for hospitals and medical facilities to communicate internally as well
as with other emergency responders during a disaster. It provides a flexible
organizational structure to activate and deactivate sections as needed. All
personnel should know the steps for activating HICS.

SECTION V. STUDENT EVALUATION

Testing NOTE: Students will be required to complete a 30 question multiple choice exam.
Requirements

Feedback NOTE: Feedback is essential to effective learning. Schedule and provide feedback on the
Requirements evaluation and any information to help answer students' questions about the test. Provide
remedial training as needed.

D-11