For Official Use Only

COVID-19 Pandemic
​Incident Action Plan (IAP)

Operational Period 12: 05/25/20 - 06/01/20  08:00am - 08:00am

HICS 201 Incident Briefing

*Situation Summary:

• Task Force SitRep click here
• ​Targeted Testing of GRHC Employees - approx. 1,868 completed as of 05/28/20
• Targeted Testing of Community Members - approx. 892 completed as of 05/29/20

 

• Community COVID-19 Cases  |  data link
  • *GRIC confirmed positive: 28
  • **GRIC Total Tests Performed: 7,381
  • Deaths: 2
    (*GRIC cases are those cases that reside within the boundaries of the Gila River Indian Community. This        does not necessarily reflect the current number of active cases but reflects the total since testing began. Data source: GRIC Tribal Health Department
    **Count includes GRHC Patients, GRHC Employees, GRIC Dept and Enterprise Employees, and retests​)
• ​GRHC Census Information (updated 11:30am daily)
  • HHK Inpatient
    • 2 Inpatients (no COVID)
    • 5 available Negative Pressure beds
    • 5 available regular beds
  • HHK ED
    • 0 inside regular room
    • 2 inside negative pressure room 
    • 1 outside regular area 
    • 3 outside negative pressure area
    • 8 available regular beds
    • 14 available negative pressure beds (7 inside, 7 outside)
  • RTHHC Field Hospital
    • 0
  • TCH
    • 72 Residents 
    • 28 Open Rooms
  • RTC
    • WRTC:  5 clients, 18 open beds
    • WTLC: 4 clients, 6 open beds
    • MRTC: 8 clients, 13 open beds
    • MTLC: 2 client, 8 open beds
      
      
    • Bldg 300 (Quarantine): 3

Health and Safety Briefing:

• Follow the guidelines on the ICS 208 Safety Message and HICS 215A Safety Analysis
• Maintain physical distancing
• Refrain from shaking hands and other close body contact
• If you are sick, stay home
• Keep informed

​

HICS 202 Incident Objectives

IMT Directives (ELT/BOD driven)

• Provide care to all patients who present as a result of the COVID-19 event.
• Provide for the safety of GRHC staff.
• Conduct initial and ongoing communications with internal staff and external response partners.
• Conduct screening for all patients, visitors, and staff at Entry points of each Building/Facility.
• Provide for public health with effective after care to those in quarantine.

Incident Objectives (Incident Commander driven)

• Limit access and provide access control to all facilities.
• Implement and evaluate department strategies to secure PPE and medical supplies.
• Coordinate with GRIC task force to provide care to those in quarantine.
• Communicate with Branch Directors and Group Supervisors to identify challenges, Communicate and evaluate strategies and tactics.
• Prepare and submit plan elements to the Planning Section by 1100 daily in preparation for the 1130 Planning Meeting.
• Update the online IAP for all staff to access and stay informed.
• Provide Messaging and training for screening personnel to address employee and patient/visitor screening. 

Command Emphasis

• All organization-wide communication will be through the PIO with Incident Command and Executive approval
• Stay Focused on your assigned HICS 204 Assignments form.

HICS 203 Organizational Assignments List

Incident Commander	Div Chief Patrick Peterson
Senior Advisors	.
BOD/ELT (Policy Group)	GRHC BOD / GRHC ELT
Human Resources	Denise Murphy
Employee Health	Lisa Gillern
​Safety Officer	Stacy Welch
Liaison Officer	Kelsey Adams
Public Information Officer	Veronica Vaughn
Planning Section Chief	Kathie Dumais
Finance Section Chief	Doug White
Logistics Section Chief	Mario Torres
Support Branch Director	Angie Downs
​Service Branch Director​	Lenora Mora
Operations Section Chief	Steve Schoffstall
Acute Care Branch Director	Lindsey Silva
Non-Acute Care Branch Director	Doug Huber
Security Branch Director	Lantz Biles
The Caring House Branch Director	Ron Preston

HICS 204 Assignments - Acute Care Branch

Operations Section Chief	Steve Schoffstall
Acute Care Branch Director	Lindsey Silva

Acute Care Group: ED | EMS | Inpatient | DRS

Group Supervisor: Steve Melin

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Continue to plan for patient surge​ throughout OP12	Continue procurement of needed supplies Install toilet in mobile hospital ​ Set up needed IT equipment	O2 generator, O2 piping, toilet, Phone, computers, iPads	​ED Mobile Unit Inpatient
Monitor PPE supply and ensure all units have appropriate PPE	Monitor PPE daily tracking report Sign off 213RR’s	All PPE	​ED ​Inpatient Mobile Unit Supply Unit
Enclose ED breezeway to climate control The employee/patient screening station.	Finalize fire sprinkler plan Obtain fire marshall approval Install fire-suppression sprinklers ​ Install drywall	​Fire sprinklers, drywall, related building supplies	ED ​Facilities Mgt.
Monitor Inpatient census and continue to Increase ability for higher acuity patients	Daily reporting of inpatient census Perform Pediatric gap assessment  ​ Identify PALS certification trainer	​Inpatient census report PALS certified trainer	Inpatient
EMS will complete COVID Testing	Test EMS staff every two weeks	​Refer to targeted testing group Action plan	EMS
Continue participation in weekly town halls	Dissemination of most up to date information via weekly Webex	-	EMS
​continue participation in drills/training at RTHHC Field Hospital	​Participation in mock trainings	-	EMS
Continue Glidescope Staff Training Development	Build department training program on Glidescope use (in process) ​ Develop employee training schedule	​Glidescopes Training room Educator	EMS
Obtain 3M P100 large size masks and filter cartridges	​Work with employee health on sizing/ fit	​3M P100 masks Filter cartridges	EMS ​Employee Health
​Isolate and test new inmates to Reduce transmission risk	Continue to test new intakes daily. Test at ED if medical clearance is required. Mask and quarantine new intakes until test results are available	​Labor pool RN staff Testing kits Daily communication with IP/DRS	DRS
Ensure safety of inmates by identifying symptoms and ensuring infection prevention strategies are in place	Daily temp and symptom monitoring by med staff Deliver/setup additional Illuvia unit ​ Enforce social distancing	​Thermometers DRS Medical Staff Illuvia units/filters	DRS
Address barriers to OTTO telehealth platform	Pilot agreed upon utilization of Dedicated iPad for OTTO platform Removing HIPAA compliance issues	​Computer WIFI Software	DRS

Public Health Group: Primary Care | PHN | School Health | Screening

Group Supervisor:  Dr. Viji Murugavel

Objective	Strategy/Tactic	Resources Required	Unit Assigned
​Begin shadowing to take over Employee screening process for back to School transition.	Speak to managers about utilization of Specific staff Shadow current manager Identify team to transition process to	Manpower	SHS
COVID-19 patient monitoring - ongoing	Phone calls every 48h to assess symptoms And reinforce quarantine, 7 days/wk Home visits as necessary	Office and cell phones GSA vehicles PPE	PHN
​  Medication and supply Delivery - ongoing	​Delivery of  medications and Necessary household supplies primarily by District PHN’s with support from School Health Staff	Manpower	PHN ​SHS
Provide support for COVID-19 Targeted Testing	Support expanded testing efforts For community members	Refer to Targeted Testing Plan	PHN
​Support temporary quarantine housing	​Maintain a safe space for GRIC Residents who are COVID+ and have no space to quarantine for 14d	​  RTC 300 building	PHN ​BHS
Monitor daily census of patient screening area and PCD dept staffing	Decrease staff to meet census needs. ​Free up staff for labor pool training	Census reports ​Staff	HHK PCD ​KHC PCD ​AKC
Continue utilization of telehealth platform for appropriate outpatient visits ​​	​Utilize OTTO telehealth platform For non-urgent outpatient visits	​Computers with microphone and speakers	HHK PCD KHC PCD ​AKC ​IT
Perform follow up to Community Members with surveillance testing results	Attempt 2 phone calls, then send letter advising of results	​Phones ​Spreadsheets	​HHK PCD KHC PCD ​AKC

Dialysis Branch: Dialysis East | West

Branch Director:  Angie Bittoon

Objective	Strategy/Tactic	Resources Required	Unit Assigned
​Continue to distance, isolate,  and treat PUI’s and COVID+ Patients in Dialysis isolation area	Ensure dedicated staff assigned daily   Ensure PUI’s are spaced 6” apart in PUI cohort area	Dedicated machines, spaces and staff for COVID+ and PUI’s	Dialysis Group
Monitor PPE supply and ensure all staff are adhering to re-use policy	​Continue submission of 213RR’s Visual monitoring of staff compliance	​Isolation gowns, face shields, masks, Shoe covers, gloves Infection Prevention	Dialysis Group
​Continue to provide weekly information to dialysis patients	Weekly rounding by staff to answer Questions, address concerns, and Provide most current info on COVID	CDC, WHO resources Staff	Dialysis Group
​Continue to develop process for Dialysis Treatments are The Caring House	Estimated start June 2nd ​Nxstage will do virtual training May 27 then hands on on May 28, 29 and June 1 Onboard new Dialysis staff	Dialysis equipment ​Staff	Dialysis Group ​TCH Group HR Facilities ​IT
​Continue to develop process for Dialysis Treatments at Inpatient	Estimated start June 2nd Finalize policies for Inpatient	3 Dialysis machines/RO Ancillary equipment	Dialysis Group Inpatient  ​PCD Facilities ​
Continue to develop process for Dialysis Treatment at RTHHC	Estimated start mid-late June Finalize policies ​ Finalize contract with outside Nephorologist for Privileges	​Dialysis machines/RO Ancillary equipment	Dialysis ​RTHHC FHG

Scrubs Task Force

Task Force Leader: Ella Dayzie

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Decrease risk of COVID exposure to staff and Community	Accurate sizes, numbers and utilization reporting. Timeline: May 22, 2020   Use application to get list of users, merge user ID# with scrub size, home department and finance codes ​Determine if GRHC wants to develop an automatic scrubs distribution center or identify distribution center (location) on GRHC campus. Send plan/cost for approval to ELT	Manpower	Scrubs Task Force

HICS 204 Assignments - Non-Acute Care Branch

Operations Section Chief	Steve Schoffstall
Non-Acute Care Branch Director	Doug Huber

Central Sterile Group:

Group Supervisor:  Janice Nachie

Objective	Strategy/Tactic	Resources Required	Unit Assigned
​Pursue obtaining UV disinfection units for N95 and PPE	​PPE availability currently adequate.  Research and identify available UV units (size, mobility, functionality) and costs for potential purchase and use. Safe, reliable, validated processes continue to lead back to a vaporous hydrogen peroxide (VHP), low temperature system with biological and chemical indicators for sterility assurance for safe usage. No reliable, safe, cost-effective UV systems found for our smaller area space (4’ x4’ square) usage purposes.  Only large expensive designs for clean rooms without cloth, flat surfaces, and without shadows.	Computer for internet search Assigned individual(s) for research. Assimilate data (i.e. spreadsheet or bullet points) for Director review	Central Sterile
​Support cleaning and sterilization for surgical instrumentation	​HHKM – CSD will continue to support cleaning and sterilization surgical instrumentation	Sterilization Technician, department driven supplies will need to be ordered.  PPE level 3 gowns remain on back-order.	Central Sterile

Ancillary Care Group: Lab | Pharmacy | Medical Imaging | Patient Registration

Group Supervisor:  Peggy Hunkele

Objective	Strategy/Tactic	Resources Required	Unit Assigned
​Re-open MRI on 06/01/20 M-F 8a-430p at RTHFH	Place parking signs	Parking Signs	MI
Pharmacy to obtain supplies, medications, and staffing for RTHFH	2 additional crash carts back-ordered – still pending ​ Repurposed one with a key lock and looking for another. All crash carts meds are available on the floor in Omnicell®. Supplies have been obtained.   Hood recertification of the IV Room and Ante Room were completed	New crash carts	​Pharmacy
​Laboratory ​COVID testing, supplies, and support continues.	Continue all testing activities.	​​Supplies needed	​Lab Supply Unit

Outpatient Care Group: Dental | Life Center | Optometry | PT | Podiatry | Women's Clinic

Group Supervisor:  Dr. Dean Fasciani

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Ensure ongoing daily Essential and emergent patient care needs are met on an ongoing an timely basis	​Continuous monitoring of PT, Dental, Podiatry, Optometry and Women’s health	​Same equipment and supplies as routine operations	​All 6 outpatient care group Service line directors and subordinate managers.
​Provide excess staff to labor pool	Most of Surgical Service Departments have greatly reduced services and have many staff in labor pool Weekly submissions of available staff to labor pool Tracking staff	​Weekly submissions from managers to labor pool	​All 6 outpatient care group Service line directors and subordinate managers.
​Provide and monitor HHK PT space for employee scrub program	​PT dept will provide access and support for the employee scrub program donning an doffing	​HHK PT Building / Treatment cubicles, Oxivir wipes, Dirty bins for scrubs	PT EVS ​Logistics
Continue to manage the environment	Review with all staff cleaning and use of PPE.  Disinfect all equipment between patient use	​​PPE Items Oxivir Wipes	Outpatient Care Group​
​Optimization of PPE: Monitor and secure PPE supply	​-Request PPE items by submitting a Resource Request Form (HICS 213RR) to Branch Director - Operations Section Chief -Secure PPE per dept plan -Udate PPE lists daily	​PPE Items HICS-213RR	Outpatient Care Group
​Manage and disseminate information to subordinate clinics and back up the chain to leadership	​​Email, Huddles, Rounding, Meetings	Communication Tools	Outpatient Care Group
Dental preparing for increased volume do to demand and aerosol generating procedures.	Meet as needed with Infection Prevention, Operations Chief, Safety Chief and Facilities to assure process and air flow is optimized for staff and patient safety. Illuvia unit for air disinfection scheduled to arrive 5/29/20. Look into disinfecting fogging system for overall room and contents disinfection between procedures. Facilities can adjust air flow to create negative pressure in 6 select rooms	​Illuvia unit, Fogger, Air flow units.	Outpatient Care Group Facilities Mgt ​SOFR
​Women’s Health Care preparing for increase in waiting room volume to comply with social distancing.  ​COMPLETED	Meet as needed with Infection Prevention, ELT, Safety Chief to assure process meets with CDC recommendations WHC to reevaluate periodically for compliance.	Facilities for furniture movement and placement. Reevaluation by WHC staff for compliance.	Outpatient Care Group Facilities Mgt ​SOFR

BHS Group: New Beginnings | Oasis | RTC | RTHHC | Shegoi

Group Supervisor:  Kerry VanVolkinburgh

Objective	​Strategy/Tactic	​Resources Required	​Unit Assigned
Monitor all incoming patients for COVID-19 symptoms	Ask each patient/staff the screening Questions.	​Screening questionnaire	BHS RTC
​Monitor PPE supply	​Utilizing PPE Plan and Optimizing PPE Supply Policy, monitor supplies and maintain a minimally appropriate level	​Staff assigned to monitor and HICS-213RR form	BHS ​RTC
​Maintain BHS presence to provide crisis services and support for remote staff.	Continue crisis services per best practices and GRHC policy/procedures	​Policies and trained Staff	BHS

Quarantine Housing Task Force

Task Force Leader: Shannon Sims

Objective	​Strategy/Tactic	​Resources Required	​Unit Assigned
Establish a Quarantine site at RTC building 300 to quarantine up to 11 COVID-19+ persons who have no options to quarantine at home or elsewhere.	Coordinate with Public Health Nursing for ongoing operations.	​GRHC: Food service, IT , security, EVS, Linen, Transportation, PHN, Risk GRIC: Tribal Social Services, OEM, Housing Fence ordered ETA week of June 7	Quarantine Housing TF ​PHN

flow_chart_emergency_quarantine_housing_rtc_building_300_05-18-20.pdf
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RTHHC Field Hospital Group

Group Supervisor:  Michelle Kopec

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Obtain 24/7 Staffing coverage for the Field Hospital	Schedule all labor pool staff shifts and times. Obtain information on assigned staffs skills and competencies. Obtain additional staffing as needed to cover patient census. Increase staff numbers to accommodate 50 patients.               100% of completion for 50 patients for optimal condition. Working on 20% overage to cover call outs and PTO and Leave.	RN Scheduler Labor pool ​Scheduling spreadsheet	Labor Pool RTHHC FHG ​ELT ​
Ensure all appropriate equipment is procured.	Identify equipment that has not been received. F/u with vendors for ETA. ​ Find suitable replacement equipment. 90% equipment identified 70% completion due to arrival of supplies. Many varied ETA’s	List of required equipment Materials Management and IT personnel PCD, Pharmacy personnel and various currently identified equipment ​	Supply Unit ​IT Unit
Ensure all appropriate Supplies are procured.	Identify patient supplies not available   Stock supply rooms with needed supplies. 90% equipment identified ​ 80% completion due to arrival of supplies. Many varied ETA’s	List of patient supplies that are needed.   Staff members to stock supply rooms.	Supply Unit
​Ensure all Processes for patient care are established and vetted.	Complete mock patient run throughs. ​ Develop processes that work at RTH Field Hospital. 95% of processes identified ​ 98% of guidelines developed and being vetted.	Recorder to create a list of identified gaps in processes during mock run through   Policies and Procedures.	​Logistics and Ancillary Care Group, Lab, Pharmacy,  Medical Imaging, Patient Registration, Food Service
Ensure ​Electronic Medical Record is operational and staff are trained in use.	Train Identified staff members in RPMS   If unable to train prior to opening, will use paper down time forms.   Collaborate with IT to set up training classes.   Identify and train RPMS super users. 100% of staff trained	​Schedule IT Trainers/Super users for training classes   Obtain and review forms and staff to review   Train Charge Nurses and identify and additional staff	IT Group Labor Pool  ​Inpatient Group ​RTHHC FH Group
Schedule Mock Patient Tracers to identify processes and gaps in processes.	Schedule daily Tracers to identify gaps in process   Schedule day long Tracer(s) to further identify gaps in process   ​6 Day long mock patient days completed. We continue in two weeks as after Provider training is complete.	All associated department representative for input in process	​PCD, Lab, Pharmacy, Food Service, Materials, IT, Imaging, Customer service, Registration
Schedule and complete training of identified skills for RN’s and Nurses	Identify skills training needed to care for medical/surgical patients.   Identify staff/people skilled and available to train staff.   Skills and training labs to be done weekly.  ACLS certification classes weekly	List of needed skills. List of resources or people with certain skills. People to staff the needed stations. ACLS Instructor	​RTH Field hospital Staff, Educator, EMS, NP’s, Labor Pool
Identify staff’s completion of COVID-19 specific training in Bridge	​Review Bridge spreadsheet of staff assigned to: COVID-19 for Clinical Staff Hand Hygiene: The Basics Self-Paced Personal Protective Equipment Regulation Express: Transmission-Based Precautions Verify completion, address staff who have not completed and assign to those who need. ​95% completed	​Specific spreadsheet from Bridge and staff	HR ​RTHHC FHG
Obtain 24/7 provider coverage for the field hospital.	Recruit Providers from outpatient areas who are wanting to work inpatient. 8 MD’s obtained 7 NP’s obtained	Schedule of how many providers needed and hours to be worked.	​RTHHC FHG Acute Care Group ​Public Health Group
Create training program for identified providers for the Field Hospital	​Identify skills training needed to care for medical/surgical patients.   Identify staff/people skilled and available to train staff.   Identify days to perform training.   ACLS certification classes weekly.	​List of needed skills. List of resources or people with certain skills. People to staff the needed stations. ACLS Instructor.	​RTHHC FHG ​Acute Care Group
Create plan for Demobilization of the Field Hospital	Identify all equipment that needs to be stored/returned. Identify supplies that can be saved for future use and supplies that will be used now. ​ Identify what equipment and supplies need to be returned to their original state.	List of equipment that needs to be stored and locations. List of supplies that can be stored and location. List of what needs to be returned to original departments.	​RTHHC FHG, Logistics, and Ancillary care groups.

Targeted Testing Task Force

Group Supervisor:  Dr. Dean Fasciani

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Develop a comprehensive targeted testing plan for GRIC members, GRIC employees and GRHC healthcare workers	Develop a written action plan identifying task force needs and assignments	List of departments, directors and staff capable of carrying out outlined directives	Targeted Testing Task Force ​Operations
​Ensure task force is held accountable for directives.	Initial Webex to discuss targeted test plan and assign directives with periodic follow-up meetings every 1-3 days to determine status of directives	-	Targeted Testing Task Force
Continue training and competencies for all individuals involved in field testing	Identified qualified instructor to sign off Determine location,  Dates, and times.	​Large room within HHK capable of holding 10-12 people.	Targetes Testing Task Force ​SOFR
Continue testing employees and patients in the targeted cohorts listed in the action plan.	Schedule dates/times at locations Communicate with Directors ​ walk-thru site locations Order PPE, supplies	PPE, supplies Conference rooms, bathrooms	Targeted Testing TF Employee Health TCH Branch
Continue testing all interested GRIC members.	Schedule dates/times at locations. Communicate with key GRIC individuals.   Walk-thru site locations. Order PPE, supplies. D4 is completed and will move to D5 next week.	PPE, supplies. Applicable sites, rooms, bath rooms. EMS on site.	Targeted Testing TF
Begin retesting specific cohorts based on action plan	Schedule dates/times at locations. Communicate with Directors. Order PPE, supplies. Start Employee re-testing June 1st.  Retest Dialysis East patients and staff. Start RTC patients	PPE, Supplies Conference rooms, bath rooms	Targeted Testing TF TCH Branch Dialysis Group

HICS 204 Assignments - The Caring House Branch

Operations Section Chief	Steve Schoffstall
The Caring House Branch Director	Ron Preston

Resident Care Group	Group Supervisor:  Theresa Ratliff
​Support Group	​Group Supervisor:  Billy Estrada
Logistics Group	Group Supervisor:  Max Haake

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Provide in-house Dialysis to TCH Residents	​Provide segregation from the general population when transmission based precautions are necessary and to offer in house HD to TCH residents to avoid contact outside of TCH. Establish TCH inpt. dialysis as allowed under a CMS blanket waiver.   The rooms on the hospice side are reserved for in house hemodyalysis (HD).  Estimated opening date is 6/2/20.  HD machine ETA is the week of 5/25/20.  Finished laying the flooring. Additional HD supplies arrived on 5/21/20.  Complete the pony wall to cover the electrical and drainage by 5/29.20	HD equipment/supplies, HD staffing HD machines, chairs and associated equipment and supplies.  The HD dialysis center will staff and operate the HD services. A determination will be made to set up chairs in the large common area or in the rooms on this Unit.  The carpet will be removed.	Dialysis ​TCH
​TCH residents and staff CV-19 testing on an alternating weekly basis.	Identify any asymptomatic residents and staff.  Implement further mitigation actions as necessary.  ​Maintain regular communications with residents, families/representatives and staff on the testing schedule and results. ​Perform mitigation and response measures when positive results are reported among staff or Residents	Utilize TCH trained nursing staff to perform the testing and send to the appropriate lab(s).  ​ Assure necessary orders are entered into NG.	TCH  ​Targeted Testing TF
Ongoing ​Resident/Family communication	Providing written updates to residents and families on TCH COVID-19 mitigation actions.  This will soon be a CMS requirement nationwide effective 5/17/20.  A written communication on  positive test results provided to residents.  Personal telephone calls provided to families/representatives.  Maintainin a "diary of actions and efforts taken on a weekly basis.  The administrator creates the bullet points then sends the information to PR to package the content to be mailed to families and distributed to residents.	Communication Topics	TCH Branch ​PIO
​Audits of hand washing and PPE will be conducted	Environmental audits are being conducted, this includes tagging surfaces and checking the thoroughness of the cleaning with with a UV light.   Distribute the audit forms to both nursing shifts to perform.  These audits will be saved for potential review by CMS at some point.   Audits are performed, returned to TCH infection preventionist for review and necessary follow-up on education.   Staff development will assure that education on hand washing and PPE use by staff is brought into the 90% completion range.	Staffing Audit Forms	TCH Branch

tch.120.107_public_health_emergency_covid_19_revised_time_lines.pdf
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HICS 204 Assignments - Security Branch

Operations Section Chief	Steve Schoffstall
Security Branch Director	Lantz Biles

HHK Group	Group Supervisor:  On-Duty Sergeant
​RTH Group	​Group Supervisor:  On-Duty Sergeant
KHC Group	Group Supervisor:  On-Duty Sergeant​
BHS Group	​Group Supervisor:  ​On-Duty Sergeant
​Dialysis Group	​Group Supervisor:  On-Duty Sergeant

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Maintain 24/7 Security support of all functioning GRHC facilities.	Continuous monitoring of available manpower. Implementation of workforce triggers.	Manpower	Security ​Labor Pool
​Provide Security support for all patient screening locations during operation.	​Continuous monitoring of available manpower. Implementation of workforce triggers.	Manpower	​Security ​Labor Pool
Implement crowd and traffic control protocols as needed. ​	Block/control access to identified parking areas and testing areas.	Manpower	Security
Provide after hours Security support for the issuance of scrubs at various locations. ​	​Provide manpower and supervision for the accountability of clothing items.	Manpower	Security Labor Pool ​Scrubs Task Force
​Block lot(s)/drives(s) to protect & control access to equipment.  ​COMPLETED	Provide barriers and/or manpower at identified entry points	​20 Jersey Barriers	Security ​Service Branch

HICS 204 Assignments - Support Branch

Logistics Section Chief	Mario Torres
Support Branch Director	Angela Downs

Customer Service Group	Group Supervisor: Josette Sanchez
​Supply Unit Group	​Group Supervisor:  Mark Robles
Transportation Group	Group Supervisor:  Melissa Notah
Human Resources Group	​Group Supervisor: Denise Murphy

Objective	Strategy/Tactic	Resources Required	Unit Assigned
​Support Customer Service in providing quality care for the patient	Reps to be proactive and available at entrances. ​ Ensure reps safe with proper PPE and training	Education resources PPE	Customer Service ​Infection Prev.
Continue to locate and obtain supplies and equipment (ongoing)	Remain in contact with all contracted vendors ​ Ensure following proper process for orders by submitting complete 213’s Alternate routes for obtaining supplies – i.e. IHS, etc.	​all requested supplies	​Supply Unit Facilities Mgt. Security
Continue to support Employee Health GRHC Surveillance Testing	Update daily ETSP numbers in Spreadsheet. 2nd round of employee testing starting 6/1. Investigating exposures, secondary screenings/testing of GRHC staff, and return to duty screenings for staff	COVID test kits	Employee Health LP Clinical Staff
Support Transportation in providing safe environment for staff and riders (ongoing)	Policy and protocols per IP Keeping same driver with same rider drivers needing biohazard training for those who will be transporting for targeted surveillance team. Mask (N95 and procedure) education with drivers and IP Nurse, Diana	​    Disposable seat covers Masks for Riders     Bags Non-emergent transportation, EMS/MTS vehicles	MTS EMS Employee Health SOFR PIO
​Continue identifying labor pool positions with staff at locations needed.	​Updated Excel Template for department reporting. Meeting with dept directors regarding LP process to keep them involved and for accountability with employees. Proposal for agency RN’s presented to ELT and moving on to Board approval. Identify those employees to bring back from child care leave	Excel Template Power Point Instruction for Directors Power Point/Excel Data for ELT LP Request Form 5.12.20 (in X Drive under Labor Pool)	Labor Pool
​Labor Pool continue to provide staffing for RTH Field Hospital to prepare for surge	​Weekly spreadsheet in LP Folder Working with RTHHC FHG and HHK PCD to schedule RN/MA training in mid-June	Supply and Staffing List	RTHHC Field Hospital Task Force Labor Pool Supporting departments
Create a PAR for RTH field ​hospital warehouse supplies.	Define system setup Locate staging area. Define replenishment process Define supply needs ​Ensure all new equipment has asset tags	​Shelving Carts Staff Supplies Asset tags	Supply Unit RTHHC FHG

HICS 204 Assignments - Service Branch

Logistics Section Chief	Mario Torres
Service Branch Director	Lenora Mora

Facilities Group	Group Supervisor:  Keleto Sili
EVS Group	​Group Supervisor:  Curtis Osife
Food Service Group	Group Supervisor:  Lenora Mora
IT Group	​Group Supervisor:  Scott McCrimmon

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Continue to Support build-outs of surge space at HHK and RTHHC	​Moving equipment Set up negative pressure areas	staffing and supplies up to an including outside contractors	​Facilities Mgt
Perform Daily testing of the Negative air, Isolation room and Negative air space. HHK, KHC, RTH and TCH	Daily testing	-	Facilities Mgt.
Add fire sprinklers to the ED entrance canopy to allow for screenings to continue	Obtain approval from Fire Dept 5/29-Flow test for Fore line design and drawing to be approved by FD ETA 6/5	TBD per quote	Facilities Mgt.
Acquire portable toilets for ED COMPLETED	Rent 2-stall toilet for outside the ED ​Rental agreement PO in process, ETA 5/29/20	Rental	Facilities Mgt.
Provide additional Emergency power for RTH	​Currently working with contractor on the budget ETA July 2020	​Electrical equipment and contractor	Facilities Mgt.
Portable additional showers and toilets for RTH	Plan to purchase 6 stall portable shower/toilet. ​ 2 of the stalls will convert to one ADA accessible total of 5.	​Rental portable shower/toilet	Facilities Mgt.
Provide support for Dialysis use in Inpatient	Temporary solution to use Podiatry exam room 10 for storage and disinfectant of machines.	Space, water, electricity 5/20-changed faucet handles on sink adding garden hose fitting	Facilities Mgt.  PDC
Provide support for Dialysis use at The Caring House	Construction of walls, plumbing, and electrical beginning 5/20 for 6 chairs	Space, water, electricity ETA of completion 5/28	​Facilities Mgt.
Provide negative pressure to 8 rooms in Dental	Get proposal from contractor to add exhaust in 8 chair rooms	TBD per quote	​Facilities Mgt.
Value	Value	Value	Value
Value	Value	Value	IT
Continue to ensure all areas remain clean	​Prioritize cleaning schedules determine staffing requirements to ensure clinical cleanliness	​staffing and supplies​​	EVS
​​Provide support to Scrub Task Force	​​Store all clean scrubs in designated areas Pick up dirty scrub bins for Cintas pick up Clean don and doffing areas routinely	​Space allocated and bins on back order Schedule in place and will be adjusted as needed	EVS
​​Continue to provide Food Services to HHK inpatients and patietns at alternate care sites	Determine how food will be prepared and delivered to alternate care sites other than HHK	​Staffing and supplies   3 food carts in process no ETA	Food Service
​​​Continue to provide IT capability to all GRHC sites including alternate care sites	Ensure IT services are available at all sites and Alternate Care Sites	Staffing and supplies up to and including outside contractors​	IT
Work with RTH Field Hospital staff to put together Philips Telemetry purchase, Survey wireless	Survey the wireless and return results to Philips, follow up with contracting.   Awaiting project update from Phillips ​ Reached out for update 5/28 with no response continue to make contact for update.	Staffing and equipment ​​​	IT​
Provide IT support for the Mobile Hospital Unit ​​	Ongoing wireless testing Working on solution to shoot wireless signal from the roof of Women’s Health.​	-	IT
Continue to provide support to GRHC surge expansion activities for HHK, RTHHC, and Mobile Hospital Unit	Mobile Unit Oxygen regeneration system DUE TO HHK BY 6/29/2020 Get Oxygen supply to Mobile COVID Hospital for ventilators	Referenced equipment ​staffing ​ Arrange for Med Gas Certified plumber to begin getting O2 piping in place for new O2 regeneration system so it is operational in 8 weeks	Planning, Design, & Construction ​Facilities Mgt.

HICS 204 Assignments - Finance Section

Finance Section Chief

Doug White

Objective	Strategy/Tactic	Resources Required	Unit Assigned
Continue to provide absentee report for previous day by 12:30PM	-	-	Payroll
Continue to provide Financial Cost Summary for the previous day by 2:00PM	-	-​	Section Chief
​Continue to adapt accounting system to process COVID-19 costs	-	-​	Finance
Continue to assist Materials Management with the escalation of COVID-19 related purchases including expedition of specific vendor payments.  ​	​Escalate specialized  COVID-19 related purchases including expedition of specific vendor payments.	-	Finance
Contracts & Grants Department continue to process contracts for COVID-related supplies, equipment, and services; and is applying for grant funding from the federal government.	-	-	Contracts & Grants

HICS 207 Org Chart

04-27-20_incident_management_team_chart.pdf
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ICS 208 Safety Message

HICS 2015A Safety Analysis

Safety Officer

Stacy Welch

Potential / Actual Hazards	Affected Section / Branch / Unit and Location	Mitigations	Mitigation Completed (Date/Time)
​Transmission of COVID-19 to patients or staff	All Sections	​Implement and maintain safety and personal protective measures to protect staff, patients, and visitors Monitor mask compliance (Source Control), for everyone entering GRHC facilities Increase environmental cleaning in each facility with written protocols and plans PPE Audits to ensure staff are wearing appropriate PPE or wearing PPE inappropriately Evaluate office spaces and consider moving  staff to other offices or telecommute staff  in office spaces with multiple staff working within 6 feet of one another  ​Ensure staff sit 6 feet or more away from others in break rooms, wash hands with soap and water for 20 seconds before eating or drinking, and clean environment after eating, Post signs in all break rooms.	​Ongoing throughout the entire incident
​Insufficient critical PPE supplies	Logistics /Operations	Continue to assess surge capacity and need for supplies with Operations section Monitor burn rate of critical PPE supplies Monitor compliance of reuse of PPE per PPE Optimization Policy Purchase alternative PPE (patient gowns, cloth masks, ponchos, etc.) regularly	​Ongoing throughout the entire incident
​Staff Shortages​	All Sections	​Labor pool to have a solid head count and stratification of clinical staff with the required skill sets​	​Ongoing throughout the incident
Improper doffing and/or inadequate use of PPE	Operations	Per the CDC a knowledgeable trained observer to ensure that donning and doffing processes are adhered to. Provide training on correct use of PPE	​Ongoing throughout the incident
​Staff at the RTH field hospital knowledge deficit r/t inability to read cardiac monitors	Operations	​EMS to create some training based on the ACLS algorithms with staff donned in PPE Add ECG and cardiac asses to Bridge	Ongoing as long as the field hospital is operational.
Hot temperatures	All Sections	Monitor the weather Adjust any outdoor activities as needed Provide water Ensure staff are taking breaks / rotating Adjust Targeted Testing collection times and rotate staff out as needed to prevent heat related illness/injuries	Ongoing through the season.
​Airborne contaminants from symptomatic and asymtomatic individuals r/t masks	Operations	​Audit mask compliance at HHK, KHC & RTH Order infrared thermometers for KHC to eliminate masks being removed to obtain temperatures for patients & employees
​Airborne contaminants from doors opening in negative pressure area at KHC	Operations / Logistics	​Place Illuvia unit near door that HCP use to go in and out of negative pressure area in KHC PCD

GRHC Breakroom Safety Tips

HICS 214 Activity Log

A daily HICS 214 is due by 1630 hrs daily by all Command & General Staff, Branch Directors and Group Supervisors. This log will represent your activities of the previous 24 hours. When completed, post to your ICS position folder on the X-Drive. 

Report On:

• Objectives
• Task/Assignments
• Meetings
• Successes
• Challenges
• Needs
• Example: Attended the morning Task Force Meeting (45 mins x 2 personnel)
• Example: Worked on developing our department’s employee screening process (1.5 hours)

hics_214-activity_log.pdf
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Facility Access Plans

GRHC Campus Access Maps-grhc-20
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COVID-19 GRHC Visitor Policy

covid_patient_visitor_policy_05-18-20.pdf
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Patient / Visitor Screening Process

Employee Screening Process

covid_employee_screening_flowchart_4-15-20.pdf
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Health Care/First Responder Worker Exposure Guidance

CDC Guidance

• Implementing Safety Practices for Critical Infrastructure Workers
• Risk Assessment & Public Health Management of Healthcare Personnel with Potential Exposure
• Criteria for return to work for Healthcare personnel with confirmed or suspected COVID-19
• Evaluating and Testing Healthcare Persons for COVID-19​​

PPE Optimization Guidance

Employees should wear appropriate PPE based on department policy, directives and procedures.

Due to the worldwide supply chain issues, N95 respirators (for those departments issued these) should be practicing reuse procedures. Your department should also have a procedure/policy on when an N95 respirator is used versus a surgical/procedure mask. 

​GRHC is currently in Contingency Capacity Strategy: Measures may change daily standard practices but may not have any significant impact on the care delivered to the patient or the safety of healthcare personnel (HCP). These practices may be used temporarily during periods of PPE (Eye Protection, Isolation Gowns, Face Shields, Face Masks, and N95 Respirators) shortages.​

• ​CDC PPE Optimization Guidance​
• ​​CDC & NIOSH Guidance on Extended Use and Limited Reuse of N95 Respirators
• CDC Guidance on Decontamination and Reuse of Filtering Facepiece Respirators

optimizing_ppe_supply_policy.doc
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N95 Respirator Example

Procedure/Surgical Mask Example

N95 Reuse Flyer
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Surge Plan

04-09-20_grhc_surge_consolidation_plan.docx
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Mass Fatality Plan

mass_fatality_plan_2020.doc
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Use of Cloth Masks to Slow the Spread of COVID-19

use_of_cloth_mask_to_slow_spread_covid-19.pdf
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How Long Do Coronaviruses Stay on Surfaces

Weekly PPE Burn Rates

Labor Pool FAQ and Policy

labor_pool_policy_04-03-20.pdf
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Hero Pay Policy

hero_pay_covid-19_policy_04-14-2020.pdf
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COVID-19 Emergency Leave Policy

coronavirus_emergency_leave_policy_final_200406_hr.104.82.pdf
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Sick and Emergency Pay Code Guidance

GRIC Executive Orders

03-13-20_gric_executive_order_1_state_of_emergency.pdf
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03-20-20_gric_executive_order_2_school_closure.pdf
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03-23-20_gric_executive_order_3_price_gouging.pdf
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03-23-20_gric_executive_order_4_utilities_and_evictions.pdf
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03-23-20_gric_executive_order_5_business_closure.pdf
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04-03-20_gric_executive_order_6_stay_at_home.pdf
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05-08-20_gric_executive_order_7_targeted_testing_gric_employees.pdf
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05-18-20_gric_executive_order_1_third_amended_state_of_emergency.pdf
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05-29-20_gric_executive_order_4_second_amended_utilities_and_evictions.pdf
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05-18-20_gric_executive_order_5_third_amended_community_office_closures.pdf
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05-21-20_gric_executive_order_7_amended_targeted_testing_gric_employees.pdf
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Maricopa County - COVID-19: Droplet Spread Explained Video