For Official Use Only
COVID-19 Pandemic
Incident Action Plan (IAP)
Operational Period 81: 9/20/21 - 9/27/21 08:00am - 08:00am
Situation Summary:
- Task Force SitRep click here
- For text updates on COVID-19 and other Community related information, text GILARIVER to 797979
- For text updates on COVID-19 and other Community related information, text GILARIVER to 797979
- Targeted Testing of GRHC Employees - approx. 56,976 completed as of 9/24/21
- Targeted Testing of Community Members - approx. 34,132 completed as of 9/24/21
- On Campus Surveillance Testing Weekly Numbers (9/20-9/26)
- ED Drive Thru Weekly: 155
- KHC Weekly: 42
- RTH Weekly: 32
- Community COVID-19 Cases | (See Data Dashboard below)
- *GRIC Total Positive: 3,479
- *GRIC Confirmed Positive D1 - D7: 2,766
- (*This does not necessarily reflect the current number of active cases but reflects the total since testing began. Data source: GRHC Outcomes Management & Informatics)
- Current Employee Vaccination Rate - EH Report (Updated Friday's)
- Fully Vaccinated: 1,642 - 77%
- Received 1st dose: 48 - 2%
- Unvaccinated: 442 - 21%
- Total Current Employees: 2,132
- GRHC Employees - Current Quarantine
- As of 9/22: 48
- Employee Case Positivity Rate - Lab Report (Updated Friday's)
- GRHC Employees Symptomatic: 12.3%
- GRHC Employees Surveillance*: 12.9%
- *Excludes Dialysis E/W and TCH Testing
- Employee Test Positivity Rate - Lab Report (Updated Friday's)
- Surveillance: 1.1%
- Symptomatic: 4.5%
- Total: 1.6%
- GRHC Census Information (updated daily)
- HHK Inpatient
- 5 Inpatient (3 COVID+)
- 5 available Negative Pressure beds
- 4 available Regular beds
- 0 patient pending transfer
- 0 patient recently transferred
- HHK Inpatient
- HHK ED Current Census
- 4 Patients
- Cabana negative pressure area: 0 occupied- 6 open
- Isolation negative pressure: 0 occupied - 7 open
- General Beds: 4 occupied - 4 open
- Holds: 3 waiting on transfer
- HHK ED Yesterday's Census (9/21)
- 77 Total Patients
- 2 admissions to Inpatient
- 5 patients recently transferred out
- 33 Drive Through Testing
- 17 Pediatric patients
- 0 Pediatric Admits
- 0 Pediatric Transfers
- GRIC Members currently in other Hospitals
- 46 members
- COVID+:10
- Suspected COVID+: 0
- Influenza: 0
- 46 members
- HHK Mobile Hospital Unit
- 0
- 10 beds
- TCH
- 76 Residents
- 24 Open Rooms
- RTC
- Building 300 (Quarantine): 0 guests, 7 open beds
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Health and Safety Briefing:
- Response-Related Injuries - 4 (2 heat-related; 2 fall)
- 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
- Appropriate PPE
- COVID Vaccination
- If working outdoors, make sure to stay hydrated and take frequent breaks
Warm and dry conditions continue through Thursday afternoon with slightly above normal highs for today. Slightly cooler temperatures and a slight chance of storms begins Thursday night across the region and persists on Friday
IMT Directives (ELT/BOD driven)
Incident Objectives (Incident Commander driven)
Command Emphasis
- 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.
- Monitor and report on PPE and medical supply usage.
- 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.
- Administer 15,000 Influenza Vaccines to the Community and GRHC Employees by 10/31.
- Evaluate strategies used for Influenza Vaccine to guide COVID Vaccine Planning.
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.
- Avoid freelancing and operating in silos.
- Communicate tasks, objectives and challenges with the Command and General Staff.
Incident Commander |
Div Chief Patrick Peterson |
Senior Advisors |
. |
|
GRHC BOD / GRHC ELT |
|
Sandra Speer |
|
Bob Kiesecker |
|
Carrie Trygstad |
|
Dr. Ryan Southworth |
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Safety Officer |
James Ornellas |
Liaison Officer |
- |
Public Information Officer |
Veronica Vaughn |
Planning Section Chief |
Angie Downs |
Finance Section Chief |
Doug White |
Logistics Section Chief |
Mario Torres |
|
Angie Ramirez |
|
Roland Enos |
Operations Section Chief |
Steve Schoffstall |
|
Steve Melin |
|
Michelle Kopec |
|
Ron Preston/Traci Haynes/Teresa Ratliff |
|
Lantz Biles |
Operations Section Chief |
Steve Schoffstall |
Acute Care Branch Director |
Steve Melin |
Acute Care Group: ED | Inpatient | EMS | DRS |
Group Supervisor: Diana Peters |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Monitor Inpatient and ED census and continue to increase ability for transfers and higher acuity patients |
Daily reporting of census Monitor ability to transfer patients - increased hold times for admission transfers Overflow area for ED Transfer holds and/or non-COVID patients |
Census Report Manpower |
ED Inpatient IT/IP |
Continue preparation for live patients in MHU |
Determine if any areas and processes need improvement |
Manpower Supplies/O2 |
ED Nursing PDC Facilities/Contractors |
Continue care and maintain safety of Staff and Inmates |
Quarantine any new intakes until test results available Utilize Illuvia units |
Manpower Illuvia/Filters |
DRS IT |
Continue Staff Training and Preparedness |
Continue Vapotherm testing - dry run to be done with PCH |
Manpower |
EMS |
Standby as needed at Vaccination sites |
Assist as needed in prep for upcoming events |
Manpower |
EMS |
Public Health Group: PHN | PCD | School Health | Screening |
Group Supervisor: Dr. Duc Vo |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Support temporary quarantine housing |
Monitor patients in quarantine space for COVID+ GRIC Members |
Manpower |
PHN |
Ongoing COVID-19 patient monitoring |
Testing and follow up with patients as needed |
Manpower PPE/Supplies |
PHN |
Continue Medication, Vaccine and Supply Delivery |
Delivery of medications and household supplies as needed |
Manpower |
PHN |
Continue clinic outpatient visits |
Monitor census with walk in patients, increased in person visits Diabetic clinic moved to Fridays |
Signage Test kits/Vaccines PPE Manpower |
HHK PCD KHC PCD AKC |
Continue COVID Vaccination distribution clinic |
Administer COVID vaccines in clinic, 3rd booster to those who qualify COVID clinic continues |
Manpower |
HHK PCD KHC PCD |
School Health Services to support organzation needs |
Collaborate with THD and School admin regarding contact tracing at schools Work with OMI to create real time reports for COVID vaccinations and testing Coordinating flu and COVID vaccinations with Robins team |
Manpower PPE |
SHS |
Dialysis Group: Dialysis East | West |
Branch Director: Angie Bitoon |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Continue to distance, isolate, and treat PUI’s and COVID+ Patients in Dialysis isolation area |
PUI’s are spaced 6’ apart Evaluating possible move of Isolation wall |
Manpower Designated Supplies |
Dialysis Group Transportation |
Continue Dialysis services at all necessary locations - TCH, Inpatient |
Continue to staff and stock supplies, review vendor contracts Booster (3rd) dose on hold currently |
Suplies/PPE Manpower |
Dialysis Group TCH Inpatient |
Operations Section Chief |
Steve Schoffstall |
Non-Acute Care Branch Director |
Michelle Kopec |
Ancillary Care Group: Lab | Pharmacy | Medical Imaging | Patient Registration |
Group Supervisor: Peggy Hunkele |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Pharmacy will continue to support COVID-19 Response operations |
Provide medications and support. Safe and secure COVID vaccination storage Provide support at Community Vaccination Events |
Manpower Supplies Vaccines |
Pharmacy |
Medical Imaging will continue to support COVID-19 Response operations. |
Provide Imaging support to HHK, TCH, RTH Train Night Shift staff in use of Steramist |
Manpower Portable X-Ray Unit Training Materials |
Medical Imaging IT |
Patient Registration will continue to support COVID-19 Response operations |
Provide Patient Registration needs and support Provide support at Community Vaccination events |
Manpower |
Patient Registration |
Laboratory will continue to support COVID-19 Response operations. |
Provide COVID Testing supplies and support IMT updates with testing percentages |
Manpower Test Kits |
Lab |
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 Essential and emergent patient care needs are met on an ongoing an timely basis for PT, Podiatry, Optometry, Dental, Women’s Health, Life Center |
Continuous monitoring of PT, Dental, Podiatry, Optometry and Women’s Health census and staffing plans Adjust as required |
Manpower Supplies |
Outpatient Care Group |
Continue Community Outreach with Vaccinations |
Continue Vaccine Administration & coordinate Flu Vaccine at Community locations |
Manpower Vaccines (COVID, Flu) |
COMU Operations |
BHS Group: New Beginnings | Oasis | RTC | RTHHC | Shegoi |
Group Supervisor: Kerry VanVolkinburgh |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Maintain BHS presence to provide crisis services and support for remote staff. |
Continue crisis services per best practices and GRHC policy/procedures |
Manpower Policies |
BHS RTC |
CARES Team to support GRHC staff who are experiencing mental/ emotional stress and burnout. |
Current support functions: 24/7 support line On site counselors available CARES team to merge into Employee Wellness Team Leadership training sessions to be recorded and uploaded in Bridge |
Manpower PPE/Supplies Signage |
Employee Wellness CARES Team PIO BHS Group, IT |
Quarantine Housing Task Force |
Task Force Leader: Shannon Sims |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Manage the 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. Coordinate with BHS as needed |
GRHC: Food service, IT , security, EVS, Linen, Transportation, PHN, Risk GRIC: Tribal Social Services, OEM, Housing |
Quarantine Housing TF PHN BHS |
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RTHHC Group |
Group Supervisor: Susan Cardona |
Objective |
Strategy/Tactic |
Resources Required |
|
Continue daily functions for RTH |
Screen and schedule patients as needed in participating depts |
Manpower Equipment Supplies |
RTH Group Supply Unit Outpatient/Ancillary |
Targeted Testing Task Force |
Group Supervisor: Dr. Dean Fasciani |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Continue testing of GRHC employees at all locations - HHK, KHC, RTH and Dialysis E/W |
Retest Dialysis EAST employees/patients Testing at KHC and RTH Drive up M-F DRS Testing monthly |
Manpower Supplies |
Targeted Testing TF |
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 |
Continue CV-19 testing in accordance with CMS Memo |
Memo Update - now based on county transmission rate vs just positivity rate Vaccinated staff testing 1x/week and unvaccinated staff testing 2x/week |
Manpower Supplies/Testing Kits |
TCH Branch IP EH |
Continue to maintain the safety of Residents through regular cleaning and disinfecting |
Steramist units and established deep clean protocols for terminal disinfecting and cleaning |
HEPA Filtration Units Steramist Unit |
TCH Branch |
Ongoing audits of environment, hand washing and PPE |
PPE and surface tagging audits completed at both nursing shifts Audits returned to IP for any f/u education and feedback |
Staffing Audit Forms |
TCH Branch IP |
Continue efforts for Resident needs and morale |
Cruiser program continues to address the psycho-social and emotional needs Provide dining activity area for E and F units |
Manpower Vehicle PPE |
TCH Branch Transportation and Recreation Staff Salon Staff |
Continue to prepare for additional COVID-19 IP Special Focus Surveys |
Utilize CMS audit tool to monitor PPE donning and doffing Monitor glucometer cleaning before & after use |
Manpower Supplies Audits |
TCH Branch IP |
Continue In Person Visitation - currently suspended due to positivity rates |
Positivity rates must be below 7% in both Pinal and Maricopa County - current rate 10.6% Compassion visits permitted for special circumstances |
Manpower PPE |
TCH Branch IP |
Continue to promote staff acceptance of receiving COVID Vaccination |
Provide education regarding safety of the vaccine Current rate 83% Town Hall 9/16 with Med Staff and ELT HHS proposal possible vaccine mandate |
Vaccine Manpower |
TCH |
| tch.120.107_public_health_emergency_covid_19_revised_time_lines.doc |
| tch-in-person-visitation-2021-v5pm.pdf |
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 |
Planning Section Chief |
Angie Downs |
Patient Communication Liaison |
Group Supervisor: Emily Robinson |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Ideal patient experience with consistent messaging on the patient hotline |
Negative call back team coverage 7 days/week Assist with school excuses and releases - have submitted request to ELT for uploading to NG Work with HIM to get patients needed documentation through patient portal Assisting with POST COVID clinic scheduling through outcomes report |
Manpower |
Hotline Staff PR IMT |
Customer Service Group |
Group Supervisor: Phillip Ahmsaty |
Supply Unit Group |
Group Supervisor: Mark Robles |
Transportation Group |
Group Supervisor: DeRees Clark |
Human Resources/Labor Pool Group |
Group Supervisor: Sandra Speer |
Case Management Group |
Group Supervisor: Michele Albrecht-Burke |
Employee Health Group |
Group Supervisor: Bob Kiesecker |
Scrubs Task Force |
Group Supervisor: Thomacita Sam |
Logistics Section Chief |
Mario Torres |
Support Branch Director |
Angie Ramirez |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Customer Service continue to provide quality care and service for patients / visitors. |
Proactive at all sites, Recruitment ongoing |
Education resources PPE |
Customer Service Infection Prev. |
MM continues to locate and obtain supplies and equipment |
Remain in contact with all contracted vendors Fulfill 213's and ensure adequate supplies |
All requested supplies |
Supply Unit Facilities Mgt. Security Finance |
Case Management Dept continue to providing quality care and follow-up for patients. |
Assist in obtaining needed appts, supplies and DME post d/c Assisting with Post COVID clinic scheduling |
Manpower |
Case Mgmt. Inpatient PRC |
Case Management to assist Tribal Health Departments with records |
Work with Tribal Health to provide hospitalization information for Medsis Report |
Manpower |
Case Mgmt Tribal Health |
Employee Health continues to support Surveillance Testing, Daily Duties and Influenza/COVID Vaccination planning |
Complete exposure investigation, secondary screenings/testing, and return to duty screenings New onsite location at HHK - Building 3 Surveillance testing at HHK/KHC/ RTH Incorporate flu vaccines for employees |
PPE Test Kits |
Employee Health Labor Pool IMT |
Continue assessment for current scrub numbers and use within the organization |
Scrubs reduced to 4 depts: ED, Inpt, Pediatrics and EVS |
Staffing |
Scrubs Task Force |
Provide labor pool staffing positions for various departments |
Continue to manage assignments for necessary depts LP Reserve positions assigned as needed |
LP Request Form Labor Pool Assignment Master List |
HR/Labor Pool Directors/Supervisors |
Transportation continue to provide safe environment for staff and riders |
Follow IP Policies and protocols Ongoing recruitment for drivers Work with vaccination team for patient transport |
Disposable seat covers PPE EMS/MTS vehicles |
MTS EMS |
Logistics Section Chief |
Mario Torres |
Service Branch Director |
Roland Enos |
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 |
Central Sterile |
Group Supervisor: Janice Nachie |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Continue to support build outs at HHK/RTH and convert additional negative pressure areas in ED |
Finish any needed items |
Staffing, including outside contractors Supplies |
Facilities Mgt |
Continue to ensure all areas remain clean |
Prioritize schedules with dedicated EVS staff at specific areas |
Manpower |
EVS |
Continue to provide IT capabilities to all GRHC sites including Alternate Care Site and MHU |
Standby for any IT needs including vaccination events |
Manpower Equipment |
IT |
Provide ongoing support for Surge Expansion Activity at all locations within GRHC (HHK/KHC/RTH) and MHU |
Assist with needs OGS system is full of 88.5% O2 Request to OGSI to raise levels to 93% - TBD Request new capital to purchase generators & fuel pods for MHU |
Staffing Supplies |
Facilities Mgt. PDC |
Support cleaning and sterilization for surgical instrumentation |
Support cleaning and sterilization of surgical equipment |
Manpower |
Central Sterile |
Continue to provide Food Services to HHK/RTH Inpatients and RTC Clients. |
Continue meal delivery to patients and staff (HHK and RTH) |
Manpower Supplies |
Food Services |
Finance Section Chief |
Doug White |
Objective |
Strategy/Tactic |
Resources Required |
Unit Assigned |
Continue to provide absentee report for previous day by 12:30PM |
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Payroll |
Continue to provide Financial Cost Summary for the previous day by 2:00PM |
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Section Chief |
Continue to adapt accounting system to process COVID-19 costs |
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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. |
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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. |
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Contracts & Grants |
| 3.8.21_incident_management_team_chart.docx |
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:
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 |
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
| covid-19_informational_booklet_final_8-13-20.pdf |
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| 04-09-20_grhc_surge_consolidation_plan.docx |
| copy_of_20_11-20_grhc_tiered_response.xlsx |
| 20_11-20_tiered_response_overview.docx |
| covid-19-vaccination-program-interim_playbook.pdf |
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| 10.13.20_comp_exec_order_no9_tab.pdf |
| executive_order_no._12_8.2021.pdf |
| executive_order_no_9_amended11_13_2020.pdf |
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The HUB is a central location for all COVID-19 and Influenza Related information including Surveillance Testing, Quarantine Guidelines, Influenza Vaccination Locations and much more! Information is updated 2x/month.
Internal HUB: grhc/Intranet/main.aspx?tid=628
External HUB: grhc.org/Hub/
Internal HUB: grhc/Intranet/main.aspx?tid=628
External HUB: grhc.org/Hub/
| mass_fatality_plan_06-18-20.doc |
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.
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.
| optimizing_ppe_supply_policy.doc |
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N95 Respirator Example
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Procedure/Surgical Mask Example
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| N95 Reuse Flyer |
| ghrc_imt_ppe_warehouse_report_07212021.xlsx |
Employees should wear appropriate PPE based on Department Policy, Procedures and Directives. Appropriate PPE is necessary to protect staff and patients. Below are some guidelines for the PPE staff should be utilizing.
| covid_employee_screening_flowchart_4-15-20.pdf |
