INCIDENT ACTION PLAN

LSFD COVID 19

OPERATIONAL PERIOD
03/23/2020 07:00
Date Time

To

Date Time
 Incident Name Date Time
ICS 201 INCIDENT BRIEFING COVID-19 03/17/2020 Continual
Pre-Incident Planning & Logistics
COVID-19 Pandemic response for Ohio. Ohio Governor and Ohio Department of Health Director Doctor Acton have
closed all schools, bar, restaurants, for three weeks to try and stop the spread of COVID-19. Clermont County open
their EOC as of Monday, March 16, 2020 and will be holding daily meetings with all representatives to keep everyone
updated on the COVID-19 pandemic situation.
LSFD will continue to join these meetings daily to keep updated on the current pandemic emergency.
Currently the LSFD has closed all firehouses to the public for safety reasons. Fire inspections, public education, and
smoke detector and battery installations have been stopped until the COVID-19 emergency subsides.
This plan continues to change daily and will be updated as needed.
LSFD will continue to follow guidelines for COVID-19 from the Ohio Department of Health and Centers for Disease
Control and Prevention.

Event Instructions
OBJECTIVE Community Pandemic Plan WEATHER
STAGING AREA In station MAP
INCIDENT LSFD EOC, Station 62 MEDICAL Loveland-Symmes Fire Department, Mutual
COMMAND Aid Departments, Hospital Network
COMMUNICATION Northeast Communication
Center
SAFETY MESSAGE Highly Infectious Disease

1. Unified Command Post located at LSFD EOC, Station 62

2. All crews will use PPE on any EMS detail were highly infectious disease is suspected.
3. All units will stage in quarters. Limited response on all EMS / Fire details. NECC will advise patients to move to
fresh air if possible and will be asking appropriate questions to try and screen calls.
4. Crews will have their temperature checked before entering the building and starting shift. Food will be provided
to the crews by LSFD, including NECC. No food will be allowed from food delivery services.
5. Restricting work areas to specific areas. No family, friends, or citizens allowed in firehouse during this time
period. All firehouse will be locked down for crew’s safety.
6. Fire inspections, public education, smoke detector and battery installation will be stopped. Captain Money will
be keeping a call list of people needing smoke detector and batteries.

Deputy Chief Mike Books

Page 2 of 2
 Resources Summary

Resources Type Identification Start Time End Time Location/Assignment

Current Actions Summary

A new updated emergency response plan will be released today for LSFD responses during the COVID-19
emergency. This plan will change as needed as the COVID-19 emergency changes.

Deputy Chief Mike Books

Page 2 of 2
 OPERATIONS – COVID19 SPECIAL ORDERS (LSFD and NECC):
1. All personnel will have their temperature taken twice per shift. All personnel will have their temperature checked before
entering any LSFD building by the off-duty Captain or senior paramedic. All on-duty personnel will have their
temperature checked again midway through the shift. Any person with a temperature of 100.4 or higher will be consider
having a fever and not permitted to enter the building. (Revised 03/21/2020)
2. Off-duty crews will not be permitted to leave, until all on-duty personnel have been checked and are fit-for-duty. Crews
should plan on the possibility of working additional hours (i.e. 8 or 24 hours shifts).
3. No outside personnel allowed into the building. Work areas will be restricted to only on-duty personnel of that
department. For example, fire department personnel only in the fire department facilities, NECC personnel only in
communication center, and police personnel only in police department facilities. Essential on-duty staff only.
4. No deliveries of any sort shall be made to LSFD or NECC, including door dash, uber eats, food drop offs, etc. Food will
be provided by LSFD for all stations and NECC. You can bring food from home if you wish.
5. Absolutely no outside people allowed in the building at this time. All buildings will be locked down, until the COVID-19
crisis has been mitigated. This applies to all family members, friends, or citizens of the community. If anyone comes to
the fire station for EMS they are not to be allowed to enter the facility. The crew will provide care outside the facility
following all recommended precautions.
6. All fire inspections, public education, smoke detector and battery installation, will be suspended unless absolutely
necessary. Residents should not be left with no functioning smoke detector. Smoke detector and battery installations
information must be forwarded to Captain Money for an accurate account.
7. All employees need to stay in station, unless there is an emergency. On all emergencies NECC will be asking people to
come outside if possible, to avoid any cross contamination. Only Medic crews will be sent on EMS details, unless
otherwise dictated by Command. LSFD will be scaling back our response during this COVID-19 pandemic. This
includes fire details as well, if we do not need to send fire crews inside, we will keep them outside for safety.

OPERATIONS – COVID19 SPECIAL ORDERS (NECC SPECIFIC):

1. NO Personnel outside of the NECC dispatch staff shall be permitted in NECC under any circumstances. This includes
but is not limited to on and off-duty LPD, LSFD, and HCSO staff as well as off duty NECC staff. Essential on duty NECC
staff only.
2. No deliveries of any sort shall be made to LSFD/NECC HQ, including door dash, uber eats, food drop offs, etc.
3. No one outside of LSFD/NECC on duty personnel are to be permitted inside of any the LSFD/LPD/HCSO/NECC
facilities at any time until further notice. This includes family, visitors, public education tours, etc.
4. All NECC personnel are to enter the building through the back door of the fire department and see a member of the on-
duty crew to have their temperature taken. Should any staff member show flu-like symptoms or exhibit a temperature of
over 100.4, that person will be sent home. Should this occur, one of the on-duty dispatchers will be asked to stay until off
duty relief can arrive. (With the exception of 3rd shift, adequate staffing shall be determined based on personnel). We
are doing our best to avoid a mandation list for off duty personnel but will do so should the need truly arise.
5. Due to the no delivery policy, food will be provided to the on-duty personnel of LSFD and NECC for breakfast, lunch, and
dinner until advised otherwise. You are still welcome to bring outside food with you; you just are not permitted to have it
delivered whilst on shift.
6. In terms of caller screening, on all EMS calls, if it is safe to do so, please have the subject meet the responding units at
the front door if they are able to. Obviously, this will not be the case in all instances, but for basic runs, please ask the
caller if it is possible. This prevents the closed-space exposure of our personnel.
 OPERATIONS – ENHANCED 2019-NCoV EMS RESPONSE GUIDELINES
Company Officers, as the crew Safety and Infection Control Officer, will ensure the following steps are taken prior to and while
mitigating every EMS response:

PRIOR TO START OF SHIFT

1. Crewmembers shall screen for flu like symptoms including: cough, shortness of breath, or fever at the start of shift prior to
relieving off going shift. This will occur at 07:00hrs and 17:00 every day.
2. This shall include temperature checks of all crew members. Temperature check shall also be done if the employee become
symptomatic.
3. Staff exhibiting flu like symptoms. Including temperatures above 100.4. should not assume their position on the company
and the previous shift’s staff should be held over. The Company Officer will notify the Shift Supervisor to coordinate with the
LSFD EXO to arrange relief staffing.
4. The company officer will conduct a safety briefing at the start of shift to cover all existing and updated Safety Alerts and
directives regarding 2019-nCoV

PRIOR TO EMS EVENT

5. Plan, pre-fit, and ensure that the entire crew has the full complement of PPE required to mitigate a 2019-nCoV event
prepackaged and readily accessible on the apparatus. Follow all department issued Safety Alerts related to PPE supply.

ENROUTE

6. Ensure that details of the event are communicated to the crew while enroute to enhance situational awareness.

ON SCENE
7. Inspect and ensure that all staff are appropriately outfitted in PPE. Follow guidance from (SA (20-009) Enhanced PPE)
8. Inspect and ensure that cooperating ambulance workers are properly outfitted in appropriate PPE for the nature of the call prior
to patient contact. If the ambulance crew is not equipped and prepared to don the appropriate PPE, the comp any officer will
request an additional ambulance and notify M30, the Shift Supervisor, and request and ambulance supervisor to the scene.
9. The crew member with the highest level of medical training /paramedic) to investigate the nature of the call and provide a
report to the company officer with the Conditions. Actions. And Needs necessary to safely mitigate the response and reduce
staff exposure. Part of this Investigation will include a temperature of all EMS patients. Patients exhibiting elevated
temperatures in the range of 100.4 F. independent of the nature of the EMS event. Will require the full complement of PPE
10. Develop and implement a coordinated plan for the safe treatment and transport of the patient. If using a Squad for transport,
follow Safety Alert 20-008.
11. If the crew was properly outfitted in PPE, no further contact to M30 or hospital staff is necessary post event. If the patient is
found to be 2019-nCoV+, the department will contact you after direction from County Health, if determined to be a potential
exposure, for potential monitoring and follow up.
12. If the crew was exposed to a potential 2019-nCoV patient (because of PPE failure, etc.), at the conclusion of the call, you will follow
the standing guidance for work-place exposures by taking the following steps: Contact M30 and your Shift Supervisor
13. No one other than crew and patient will ride in the squad during transport. Exceptions to this are pediatric patients, or if the
person riding is a benefit to patient care. (Revised 03/21/2020)

POST EVENT

14. In the case of non-exposure and the patient had symptom s or circumstances indicative of potential 2019-nCoV exposure (flu
symptoms, travel, family history etc.) please refer to attached coordinating algorithm. Refer to the UC Hospital’s Memo for
COVID-19/SARS-COV2 in the addendums for procedures for crews exposed to patients that tested positive for COVID-19 or
SARS-COV2.
 1. Incident Name 2. Date Prepared 3. Time Prepared 4. Operational Period
MEDICAL PLAN COVID-19 Plan March 17, 2020 Continual
5. Incident Medical Aid Station
Paramedics
Medical Aid Stations Location Yes No

All Stations Station 60, Station 61, Station 62, Station 63 X

6. Transportation
A. Ambulance Services
Paramedics
Name Address Phone Yes No

Loveland-Symmes Fire Department 126 South Lebanon Road 513-583-3001 X

Loveland, Ohio 45140

Closest Mutual Aid Medic Units Miami Township Fire Department 513-248-3700 X

Goshen Township Fire Department 513-722-3473 X

Hamilton Townshp Fire Department 513-683-1622 X

B. Incident Ambulances
Paramedics
Name Location Yes No

Miami Twp. Medic 27 Staged in their station X

Goshen Twp. Medic 19 Staged in their station X

Hamilton Twp. Medic 76 Staged in their station X

7. Hospitals
Travel Time Helipad Burn Center
Name Address Air Grnd Phone Yes No Yes No

B North Montgomery Road 10 X X

min
Jewish Kenwood Kenwood & Galbreith 15 X X
min
University Burnett Avenue 10 25 X X
min min

8. Medical Emergency Procedures

Follow LSFD protocol, LSFD Highly Infectious Disease Protocol A-110

9. Prepared by (Medical Unit Leader) 10. Reviewed by (Safety Officer)

Deputy Chief Mike Books
ICS 206
 STATION AND APPARATUS
DECONTAMINATION PROCEDURES

CDC DEFINITIONS
CLEANlNG: Refers to removal of germs, dirt and impurities from surfaces. Cleaning does not ki11 germs, but by removing
them it lowers their numbers and the risk of spreading infection.

DISINFECTING: Refers to the using of chemicals to kill germs on surfaces. This process does not necessarily clean dirty
surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading
infection.

For further detailed information see the CDC page : w ww.cdc.gov/ coronavirus/ 2019-ncov/ if-you-are-
sick/ steps-w hen-sick.html
 ON-DUTY EXPOSURE ALGORITHM

For further detailed information see the CDC page: www.cdc.gov/coronavirus/ 2019-ncov/ if-you-are-
sick/ steps-w hen -sick.ht ml
 DEVELOP SYMPTOMS

For further detailed information see the CDC page: www .cdc.gov/coronavi rus/ 2019-ncov/ if -you-are-
sick/steps-w hen-sick.html
 PUBLIC INFORMATION - MEDIA REQUESTS

APPROACHED BY MEDIA? COVID-19 has created a great deal of media and public interest,
which has been accompanied by concern, fear and at times hysteria. The media is paying close
attention and asking many questions. Those questions should be going to the Fire Chief for
message coordination with the EOC and the City Manager’s Office. If any personnel are
approached by the media, they should notify their supervisor.

We recognize that this is a difficult situation for all of our personnel. The additional complications
brought by media questions do not help us conduct routine business, however, the media can be
an asset if the messaging is coordinated, well thought out and consistent. In order to accomplish
this here are specific directions:

LINE PERSONNEL: If approached by the media with COVID-19 related questions, company
officers are directed to report LSFD EXO with: who the reporter is, what news agency they are
with, how to contact that person. The LSFD EXO will then contact the Fire Chief for guidance on
the handling of the information request. At no time shall line personnel answer questions or
conduct interviews with the media without specific direction from the Fire Chief.

COMMUNICATIONS: If you receive calls from the media with COVID-19 related questions, the
NECC Captain of Communications shall conduct fact finding. They shall determine who the
reporter is, what news agency they are with, how to contact that person. The NECC Captain of
Communications will then contact the Fire Chief for guidance on the handling of the information
request. At no time shall communications personnel answer questions or conduct interviews with
the media without specific direction from the Fire Chief.

ADMINISTRATIVE PERSONNEL: If you receive calls from the media with COVID-19 related
questions, the person receiving the information request shall forward the request to the LSFD
EXO. The LSFD EXO shall conduct fact finding. They shall determine who the reporter is, what
news agency they are with, how to contact that person. The supervisor will then contact the Fire
Chief for guidance on the handling of the information request. At no time shall administrative
personnel answer questions or conduct interviews with the media without specific direction from
the Fire Chief.
 PROCEDURE CHANGE

Since late 2019, the Centers for Disease Control (CDC) has been responding to the novel
corona virus, now named SARS-CoV-2. The disease caused by the virus is called COVID-19.
Since then the Loveland-Symmes Fire Department has been using the interim guidance from
the CDC as the basis for how we handle exposures to SARS-CoV-2 and COVID-19.

A goal of this document is to “…protect the healthcare workforce…” Fire Chief Huber has
directed that we change operations to follow the mitigation plan after consulting with our
...

medical director, Dr. Michael Anthony Policastro.

What does this operational change look like? Asymptomatic Department members, who have
been exposed to COVID-19 patients will be allowed to work. Department members may only
work if they remain asymptomatic. If they become symptomatic, they cannot work. For further
information please refer to the algorithms on the job aids provided.

This is a dramatic change from past practice. Our past practice was based on guidance from
the CDC that was current at that time. We understand that change is challenging. We ask for
the cooperation and understanding of Department members. Please also understand that this
is a fluid situation. As the CDC changes guidance, we may need to change our practice again.

Questions concerning this change should be directed through your chain of command to the
Fire Chief.

Outside Employment (Moonlighting)

All Outside Employment will be suspended for the duration of the Health Emergency for all
Full-Time Employees.

Questions concerning this change should be directed through your chain of command to the
Fire Chief.
 EMPLOYEE HEALTH

The stresses of our jobs are real. We as a Department understand that. The novel
coronavirus and COVID-19 are only making those stresses greater. We are all
concerned about our own health, the health of our family members, the health of our
brothers and sisters in the Department. This concern is adding to our already stressful
jobs.

The Fire Chief wants you to know that he is concerned about you, your health and your
stress levels. He has asked us to remind you that you have resources to assist with stress
management. Those resources are the EAP, Janet Childs, from the Bill Wilson Center,
and our Behavioral Health Team.

You can access the EAP directly by calling Magellan at 1-800-523-5668. You can also
access assistance from our LSFD Human Resource Division.

For Assistance from the LSFD Healthcare Advocate

Mcgohan Brabender Advocate Team

If you have a question or issue come up with one of your benefits, call the appropriate carrier
using the phone number provided on the back of your identification card. If your initial contact
with the carrier does not reach a desired resolution, contact our Advocate Team. Our dedicated
problem-solvers and experienced advocates are here to assist you when issues arise with
claims, billing or benefits. Monday-Friday, 8am-5pm
Phone: 937.260.4300 or 877.635.5372
Fax: 937.499.1160
Email: mbadvocates@mcgohanbrabender.com

RetireMED®iQ
RetireMED®iQ is an independent health plan advisory service specializing in both Medicare and
the Health Insurance Marketplace. Their services are provided at no cost and include:
• Trusted guidance to their ideal health plan
• Annual stress-free renewal advice
• Year-round support with complex health plan issues
Locations: Dayton and Cincinnati Advisory Centers Phone: 1.866.600.4266
www.retiremed.com/mb
Individual Coverage
Needing coverage for individuals such as dependents, students, early retirees, unemployed or self-
employed individuals, etc.? Our position has always been to help customers make good benefit
decisions. In light of all the changes in the individual market we’ve decided to partner with experts in this
area. Please go to the MB website, www.mcgohanbrabender.com, click on the Services Menu and
“individual Medical and RetireMed iQ,” then click on ‘request ticket’ in the individual section. Doing so will
submit your inquiry to Cornerstone Broker Insurance Services, allowing them to contact you directly to
provide assistance.

Financial Planning
McGohan Brabender partners with Everhart Advisors, an independent consulting and advisory firm, to
help you meet your financial goals through funding for higher-education, personal retirement planning,
establishing brokerage accounts, asset consolidation, individual life insurance, long-term care insurance,
and wealth transfer.
Helping you stay informed about coronavirus
(COVID-19)

Your costs are covered for COVID-19 tests

UnitedHealthcare is waiving your costs for COVID-19 testing provided at approved
locations in accordance with the U.S. Centers for Disease Control and Prevention (CDC)
guidelines. This coverage applies to Medicare and Medicaid members as well as our
commercial insured members. We are also supporting self-insured employer customers
who chose to implement similar actions.

The CDC is your best resource for COVID-19

The COVID-19 situation continues to quickly evolve. Go to the CDC for the latest
information on COVID-19 , including how to protect yourself, what to do if you are sick
and if you should travel.
If you think you might have been exposed to COVID-19, call your health care provider
right away. UnitedHealthcare members can find a network health care provider by signing
in to your health plan account or by calling us using the phone number on your member
ID card.
Resources for our members
Access your health plan account: Sign in to your health plan account to
find network health care providers, telehealth (virtual visits), benefits
coverage and more.

Request early prescription refills: If you need help obtaining an early

prescription refill, call the phone number on your UnitedHealthcare or
OptumRx member ID card.

Talk to your health care provider about telehealth: If your provider offers
telehealth, you can get a virtual visit in the safety and comfort of your home.
Visit coverage is in accordance with your health benefits plan. Your
deductibles, copays and coinsurance will apply.

Tap into additional telehealth resources: Where available, you can also
access a virtual visit through national providers:
If you receive your health plan through your employer, you can
access a virtual visit. UnitedHealthcare also offers the ease of a
virtual visit through our mobile app.

For Medicare members, sign in to your health plan account

call the number on your member ID card to learn about your
telehealth options.

For Medicaid members, talk to your doctor to learn about their

telehealth options.

Call with COVID-19 benefits questions: If you have health benefits

questions or need help finding a health care provider, call the phone
number on your UnitedHealthcare member ID card.

Get emotional support: Call our emotional support line any time at
866-342-6892. This 24/7 Optum Help Line is staffed by professionally
trained mental health experts, is free of charge and open to anyone.
 LOGISTICS - General Information

SUPPLY -
Anyone needing re-supply PPE, shall go through their Shift Supervisor.

FACILITIES-
Questions and concerns regarding station cleaning or other decontamination issues, will be sent to the Shift
Supervisor for further direction. The Shift Supervisor will coordinate with the Deputy Chief of Fleet and Facilities
for any mitigation issues. LSFD personnel will handle the request with the approval from the Deputy Chief of Fleet
and Facilities through Logistics to public works.
 Addendum
UC MEMO COVID-19/SARS-COV2
 College of Medicine
Department of Emergency Medicine
Division of Emergency Medical Services

19 March 2020

Re: COVID-19/SARS-COV2

Dear Chiefs and EMS Leaders:

This information supplements that in our note sent 13 March 2020 and focuses on potential need for work
restrictions, isolation, after a possible/definitive exposure to a patient with COVID-19/SARS-COV2. This
information is adapted from CDC, Ohio, and workplace recommendations. The information below is accurate as
of today, but things will change. Be nimble, ask questions, and stay up to date with reliable sources.

Prolonged close contact with a known/suspected COVID patient who WAS NOT wearing a facemask
Risk Factor Exposure Recommended Monitoring for COVID-19 Work Restrictions for
Level (until 14 days after last potential exposure) Asymptomatic EMS Provider
EMS PPE: None High Active Must wear a face mask (not
N-95) for 14 days
EMS PPE: Not wearing a facemask or High Active Must wear a face mask (not
respirator N-95) for 14 days
EMS PPE: Not wearing eye protection Medium Active Must wear a face mask (not
N-95) for 14 days
EMS PPE: Not wearing gown or Low Self with designated supervision None
gloves
EMS PPE: Wearing gown, gloves, eye Low Self with designated supervision None
protection, and face mask instead of
respirator

Prolonged close contact with a known/suspected COVID patient who WAS wearing a facemask
Risk Factor Exposure Recommended Monitoring for COVID-19 Work Restrictions for
Level (until 14 days after last potential exposure) Asymptomatic EMS Provider
EMS PPE: None Medium Active Must wear a face mask (not
N-95) for 14 days
EMS PPE: Not wearing a facemask or Medium Active Must wear a face mask (not
respirator N-95) for 14 days
EMS PPE: Not wearing eye protection Low Self with designated supervision None
EMS PPE: Not wearing gown or Low Self with designated supervision None
gloves
EMS PPE: Wearing gown, gloves, eye Low Self with designated supervision None
protection, and face mask instead of
respirator

Monitoring should be defined by the Fire Department and Employee Health/Occupational Medicine. In general,
self-monitoring involves the EMS provider measuring body temperature twice a day and reporting symptoms if
they develop. Active monitoring often involves daily check-ins with Employee Health.

No matter the level of exposure, exposed EMS providers can complete the current work shift. Showering and
changing uniforms as soon as possible is recommended if there is concern of droplet contamination (patient was
coughing/sneezing or received CPAP, nebulizer, suctioning, or other airway procedure).

Exposed EMS providers may return to work during monitoring as long as they remain asymptomatic. After a
high-risk or moderate-risk exposure, the EMS provider should wear a facemask while at work, including time

An affirmative action/equal opportunity institution

spent at the station and during non-medical details. Social isolation/distancing and cleaning measures should also
be considered.

Prevent Exposure:
Consider a “doorway assessment” to determine if the patient has signs/symptoms of COVID-19.

Whenever appropriate, minimize number of people going into the scene and being close to the patient.

The first person to enter the scene should give the patient a surgical mask to put on. (Remember that a
patient should never be put in an N-95.)

PPE:
Anyone within six feet of the patient should be in PPE. Full PPE consists of respiratory protection, eye
protection, clothing protection (gowns, etc.), and gloves.

Simple facemasks/surgical masks are an acceptable alternative to N-95 masks/respirators until the supply
chain is restored. Respirators should be prioritized for procedures that are likely to generate respiratory
aerosols, which would pose the highest exposure risk. A fit-tested overhaul mask with a P-100 filter can
be used in place of an N-95.

In case of shortage, clothing protection should be prioritized for aerosol-generating procedures, care
activities where splashes and sprays are anticipated, and high-contact patient care activities that provide
opportunities for transfer of pathogens to the hands and clothing of EMS.

Single source of information:

Please visit the CDC’s website frequently for Interim Guidance for EMS. This
is the most reliable information and is kept up to date. The CDC provides
information on PPE, procedural implications, transport, pre-notification, and
equipment cleaning. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-
for-ems.html (and QR code).

Questions:
Your medical director is a valuable source of information, and we are available to help at any time.

Most sincerely,

Jason McMullan, MD MS FAEMS Dustin Calhoun, MD FAEMS

Director, Division of EMS Associate Director, Division of EMS
Associate Professor of Emergency Medicine Associate Professor of Emergency Medicine
University of Cincinnati University of Cincinnati
Jason.McMullan@uc.edu Dustin.Calhoun@uc.edu
 Addendum
Fillable NIMS Forms
 INCIDENT BRIEFING (ICS 201)
1. Incident Name: 2. Incident Number: 3. Date/Time Initiated:
Date: Time:
4. Map/Sketch (include sketch, showing the total area of operations, the incident site/area, impacted and threatened
areas, overflight results, trajectories, impacted shorelines, or other graphics depicting situational status and resource
assignment):

5. Situation Summary and Health and Safety Briefing (for briefings or transfer of command): Recognize potential
incident Health and Safety Hazards and develop necessary measures (remove hazard, provide personal protective
equipment, warn people of the hazard) to protect responders from those hazards.

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 1 Date/Time:
 INCIDENT BRIEFING (ICS 201)
1. Incident Name: 2. Incident Number: 3. Date/Time Initiated:
Date: Time:
7. Current and Planned Objectives:

8. Current and Planned Actions, Strategies, and Tactics:

Time: Actions:

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 2 Date/Time:
 INCIDENT BRIEFING (ICS 201)
1. Incident Name: 2. Incident Number: 3. Date/Time Initiated:
Date: Time:
9. Current Organization (fill in additional organization as appropriate):

Liaison Officer
Incident Commander(s)

Safety Officer

Public Information Officer

Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 3 Date/Time:
 INCIDENT BRIEFING (ICS 201)
1. Incident Name: 2. Incident Number: 3. Date/Time Initiated:
Date: Time:
10. Resource Summary:

Arrived
Resource Date/Time
Resource Identifier Ordered ETA Notes (location/assignment/status)

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 4 Date/Time:
ICS 201
Incident Briefing
Purpose. The Incident Briefing (ICS 201) provides the Incident Commander (and the Command and General Staffs) with
basic information regarding the incident situation and the resources allocated to the incident. In addition to a briefing
document, the ICS 201 also serves as an initial action worksheet. It serves as a permanent record of the initial response
to the incident.

Preparation. The briefing form is prepared by the Incident Commander for presentation to the incoming Incident
Commander along with a more detailed oral briefing.

Distribution. Ideally, the ICS 201 is duplicated and distributed before the initial briefing of the Command and General
Staffs or other responders as appropriate. The “Map/Sketch” and “Current and Planned Actions, Strategies, and Tactics”
sections (pages 1–2) of the briefing form are given to the Situation Unit, while the “Current Organization” and “Resource
Summary” sections (pages 3–4) are given to the Resources Unit.

Notes:
• The ICS 201 can serve as part of the initial Incident Action Plan (IAP).
• If additional pages are needed for any form page, use a blank ICS 201 and repaginate as needed.

Block
Block Title Instructions
Number
1 Incident Name Enter the name assigned to the incident.
2 Incident Number Enter the number assigned to the incident.
3 Date/Time Initiated Enter date initiated (month/day/year) and time initiated (using the 24-
• Date, Time hour clock).
4 Map/Sketch (include sketch, Show perimeter and other graphics depicting situational status,
showing the total area of resource assignments, incident facilities, and other special information
operations, the incident on a map/sketch or with attached maps. Utilize commonly accepted
site/area, impacted and ICS map symbology.
threatened areas, overflight
results, trajectories, impacted If specific geospatial reference points are needed about the incident’s
shorelines, or other graphics location or area outside the ICS organization at the incident, that
depicting situational status and information should be submitted on the Incident Status Summary (ICS
resource assignment) 209).
North should be at the top of page unless noted otherwise.
5 Situation Summary and Self-explanatory.
Health and Safety Briefing (for
briefings or transfer of
command): Recognize potential
incident Health and Safety
Hazards and develop necessary
measures (remove hazard,
provide personal protective
equipment, warn people of the
hazard) to protect responders
from those hazards.
6 Prepared by Enter the name, ICS position/title, and signature of the person
• Name preparing the form. Enter date (month/day/year) and time prepared
(24-hour clock).
• Position/Title
• Signature
• Date/Time
7 Current and Planned Enter the objectives used on the incident and note any specific problem
Objectives areas.
 Block
Block Title
Number
8 Current and Planned Actions,
Strategies, and Tactics
• Time
• Actions
9 Current Organization (fill in
additional organization as
appropriate)
• Incident Commander(s)
• Liaison Officer
• Safety Officer
• Public Information Officer
• Planning Section Chief
• Operations Section Chief
• Finance/Administration
Section Chief
• Logistics Section Chief
10 Resource Summary
• Resource
• Resource Identifier
• Date/Time Ordered
• ETA
• Arrived
• Notes (location/
assignment/status)
Instructions
Enter the current and planned actions, strategies, and tactics and time
they may or did occur to attain the objectives. If additional pages are
needed, use a blank sheet or another ICS 201 (Page 2), and adjust
page numbers accordingly.
• Enter on the organization chart the names of the individuals
assigned to each position.
• Modify the chart as necessary, and add any lines/spaces needed for
Command Staff Assistants, Agency Representatives, and the
organization of each of the General Staff Sections.
• If Unified Command is being used, split the Incident Commander
box.
• Indicate agency for each of the Incident Commanders listed if
Unified Command is being used.
Enter the following information about the resources allocated to the
incident. If additional pages are needed, use a blank sheet or another
ICS 201 (Page 4), and adjust page numbers accordingly.
Enter the number and appropriate category, kind, or type of resource
ordered.
Enter the relevant agency designator and/or resource designator (if
any).
Enter the date (month/day/year) and time (24-hour clock) the resource
was ordered.
Enter the estimated time of arrival (ETA) to the incident (use 24-hour
clock).
Enter an “X” or a checkmark upon arrival to the incident.
Enter notes such as the assigned location of the resource and/or the
actual assignment and status.
 INCIDENT ORGANIZATION CHART (ICS 207)
1. Incident Name: 2. Operational Period: Date From: Date To:
Time From: Time To:
3. Organization Chart Liaison Officer
Incident Commander(s)

Safety Officer

Operations Section
Chief
Public Information Officer

Staging Area
Manager

Planning Section Logistics Section Finance/Admin

Chief Chief Section Chief

Resources Unit Ldr. Support Branch Dir. Time Unit Ldr.

Situation Unit Ldr. Supply Unit Ldr. Procurement Unit Ldr.

Documentation Unit Ldr. Facilities Unit Ldr. Comp./Claims Unit Ldr.

Demobilization Unit Ldr. Ground Spt. Unit Ldr. Cost Unit Ldr.

Service Branch Dir.

Comms Unit Ldr.

Medical Unit Ldr.

Food Unit Ldr.

ICS 207 IAP Page ___ 4. Prepared by: Name: Position/Title: Signature: Date/Time:
ICS 207
Incident Organization Chart
Purpose. The Incident Organization Chart (ICS 207) provides a visual wall chart depicting the ICS organization position
assignments for the incident. The ICS 207 is used to indicate what ICS organizational elements are currently activated
and the names of personnel staffing each element. An actual organization will be event-specific. The size of the
organization is dependent on the specifics and magnitude of the incident and is scalable and flexible. Personnel
responsible for managing organizational positions are listed in each box as appropriate.

Preparation. The ICS 207 is prepared by the Resources Unit Leader and reviewed by the Incident Commander.
Complete only the blocks where positions have been activated, and add additional blocks as needed, especially for
Agency Representatives and all Operations Section organizational elements. For detailed information about positions,
consult the NIMS ICS Field Operations Guide. The ICS 207 is intended to be used as a wall-size chart and printed on a
plotter for better visibility. A chart is completed for each operational period, and updated when organizational changes
occur.

Distribution. The ICS 207 is intended to be wall mounted at Incident Command Posts and other incident locations as
needed, and is not intended to be part of the Incident Action Plan (IAP). All completed original forms must be given to the
Documentation Unit.

Notes:
• The ICS 207 is intended to be wall mounted (printed on a plotter). Document size can be modified based on individual
needs.
• Also available as 8½ x 14 (legal size) chart.
• ICS allows for organizational flexibility, so the Intelligence/Investigative Function can be embedded in several different
places within the organizational structure.
• Use additional pages if more than three branches are activated. Additional pages can be added based on individual
need (such as to distinguish more Division/Groups and Branches as they are activated).

Block
Block Title Instructions
Number
1 Incident Name Print the name assigned to the incident.
2 Operational Period Enter the start date (month/day/year) and time (using the
• Date and Time From 24-hour clock) and end date and time for the operational
period to which the form applies.
• Date and Time To
3 Organization Chart • Complete the incident organization chart.
• For all individuals, use at least the first initial and last
name.
• List agency where it is appropriate, such as for Unified
Commanders.
• If there is a shift change during the specified operational
period, list both names, separated by a slash.
4 Prepared by Enter the name, ICS position, and signature of the person
• Name preparing the form. Enter date (month/day/year) and time
prepared (24-hour clock).
• Position/Title
• Signature
• Date/Time
 MEDICAL PLAN (ICS 206)
1. Incident Name: 2. Operational Period: Date From: Date To:
Time From: Time To:
3. Medical Aid Stations:
Contact Paramedics
Name Location Number(s)/Frequency on Site?
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
4. Transportation (indicate air or ground):
Contact
Ambulance Service Location Number(s)/Frequency Level of Service
 ALS  BLS
 ALS  BLS
 ALS  BLS
 ALS  BLS
5. Hospitals:
Address, Contact Travel Time
Latitude & Longitude Number(s)/ Trauma Burn
Hospital Name if Helipad Frequency Air Ground Center Center Helipad
 Yes  Yes  Yes
Level:_____  No  No

 Yes  Yes  Yes

Level:_____  No  No

 Yes  Yes  Yes

Level:_____  No  No

 Yes  Yes  Yes

Level:_____  No  No

 Yes  Yes  Yes

Level:_____  No  No
6. Special Medical Emergency Procedures:

 Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations.
7. Prepared by (Medical Unit Leader): Name: Signature:
8. Approved by (Safety Officer): Name: Signature:
ICS 206 IAP Page _____ Date/Time:
ICS 206
Medical Plan
Purpose. The Medical Plan (ICS 206) provides information on incident medical aid stations, transportation services,
hospitals, and medical emergency procedures.

Preparation. The ICS 206 is prepared by the Medical Unit Leader and reviewed by the Safety Officer to ensure ICS
coordination. If aviation assets are utilized for rescue, coordinate with Air Operations.

Distribution. The ICS 206 is duplicated and attached to the Incident Objectives (ICS 202) and given to all recipients as
part of the Incident Action Plan (IAP). Information from the plan pertaining to incident medical aid stations and medical
emergency procedures may be noted on the Assignment List (ICS 204). All completed original forms must be given to the
Documentation Unit.

Notes:
• The ICS 206 serves as part of the IAP.
• This form can include multiple pages.

Block
Block Title Instructions
Number
1 Incident Name Enter the name assigned to the incident.
2 Operational Period Enter the start date (month/day/year) and time (using the 24-hour clock)
• Date and Time From and end date and time for the operational period to which the form
applies.
• Date and Time To
3 Medical Aid Stations Enter the following information on the incident medical aid station(s):
• Name Enter name of the medical aid station.
• Location Enter the location of the medical aid station (e.g., Staging Area, Camp
Ground).
• Contact Enter the contact number(s) and frequency for the medical aid
Number(s)/Frequency station(s).
• Paramedics on Site? Indicate (yes or no) if paramedics are at the site indicated.
 Yes  No
4 Transportation (indicate air or Enter the following information for ambulance services available to the
ground) incident:
• Ambulance Service Enter name of ambulance service.
• Location Enter the location of the ambulance service.
• Contact Enter the contact number(s) and frequency for the ambulance service.
Number(s)/Frequency
• Level of Service Indicate the level of service available for each ambulance, either ALS
 ALS  BLS (Advanced Life Support) or BLS (Basic Life Support).
 Block
Block Title Instructions
Number
5 Hospitals Enter the following information for hospital(s) that could serve this
incident:
• Hospital Name Enter hospital name and identify any predesignated medivac aircraft by
name a frequency.
• Address, Latitude & Enter the physical address of the hospital and the latitude and longitude
Longitude if Helipad if the hospital has a helipad.
• Contact Number(s)/ Enter the contact number(s) and/or communications frequency(s) for
Frequency the hospital.
• Travel Time Enter the travel time by air and ground from the incident to the hospital.
• Air
• Ground
• Trauma Center Indicate yes and the trauma level if the hospital has a trauma center.
 Yes Level:______
• Burn Center Indicate (yes or no) if the hospital has a burn center.
 Yes  No
• Helipad Indicate (yes or no) if the hospital has a helipad.
 Yes  No Latitude and Longitude data format need to compliment Medical
Evacuation Helicopters and Medical Air Resources
6 Special Medical Emergency Note any special emergency instructions for use by incident personnel,
Procedures including (1) who should be contacted, (2) how should they be
contacted; and (3) who manages an incident within an incident due to a
rescue, accident, etc. Include procedures for how to report medical
emergencies.
 Check box if aviation assets Self explanatory. Incident assigned aviation assets should be included
are utilized for rescue. If in ICS 220.
assets are used, coordinate
with Air Operations.
7 Prepared by (Medical Unit Enter the name and signature of the person preparing the form, typically
Leader) the Medical Unit Leader. Enter date (month/day/year) and time
• Name prepared (24-hour clock).
• Signature
8 Approved by (Safety Officer) Enter the name of the person who approved the plan, typically the
• Name Safety Officer. Enter date (month/day/year) and time reviewed (24-hour
• Signature clock).
• Date/Time