3Course Objectives Outline the historical development of HEICS and HICS Discuss NIMS Implementation Activities for hospitalsLearn the principal concepts and features of HICSUnderstand the roles and relationships of the Incident Management Team
4Course Objectives (2)Understand the application and use of the HICS elementsConduct a facilitated, scenario-based exerciseDiscuss train-the-trainer strategies for implementing and teaching HICS
5Education and Training This course is presented by:The Center for HICSEducation and TrainingThe Center is a collaborative effort between the ER 1 Institute at Washington Hospital Center and Kaiser PermanenteOur mission is to provide information, education and training on HICSThe Center’s Advisory Board consists of National Workgroup and Ex-officio members from the HEICS 4 projectThe Center sponsors a webpage for additional info and updates on HICS utilization at
6Course Faculty Craig DeAtley, PA-C Ann Potter, RN, CEM Peter Brewster Director – Institute for Public HealthEmergency Readiness, Washington Hospital CenterAnn Potter, RN, CEMChief, Disaster Preparedness DivisionOffice of Emergency Services and Homeland SecurityPeter BrewsterEducation/Training ManagerDepartment of Veteran’s AffairsEmergency Management Strategic Healthcare GroupCraig Thorne, MD, MPHMedical Director, Employee Health & SafetyUniversity of Maryland Medical Center
7Housekeeping Notes All technology to “silent” or “vibrate” please If you must take or make a callWait for a breakLeave the room for callsWe will have regular breaks during the coursePlease stay within the announced break timesRestroom location(s)Emergency exitsThere will be time for Q&A- save your questions to the announced periodsPlease consult with the instructors during breaks if neededYour evaluations are important to us! Complete the evaluation form by the end of the day!
8Day 1 AgendaNIMS Implementation Activities for Hospital and Healthcare OrganizationsOrigins of HICSOverview of HICS ComponentsThe Hospital Incident Command SystemJob Actions SheetsIncident Planning & Response GuidesFormsDiscuss relationship of the hospital to its community partnersLearn about adapting HICS to rural and small facilitiesCourse Evaluation and Wrap Up
9Course CopyrightThe HICS course materials are proprietary and cannot be duplicated, reproduced or utilized without written permission of The CenterNo cameras or video taping or recording of this program are permitted
11What is the Hospital Goal? PreparednessDevelop effective Emergency Management and Operations PlansResponseEnsure safety of patients, personnel and facilityTriage, treat, transfer and disposition victimsEnsure business continuityRecoveryOperational/Business RecoveryFinancial recoveryRestoration of “normal” operations
12Implementation Activities for Hospitals and Healthcare Systems NIMSImplementation Activities for Hospitals and Healthcare Systems
13NIMS Implementation Activities for Hospitals and Healthcare Systems Document September 12, 2006Developed by NIC and DHHSOutlines the 17 Implementation Activities for hospitalsNational Bioterrorism Hospital Preparedness Program (HBHPP), administered through HRSA, outlines compliance for FY 2006 funding cycleTraining: ICS 100 and 200 and IS 700
14NIMS Implementation Activities for Hospitals and Healthcare Systems Implementation document outlines:The elementElement’s association to NIMSImplementation GuidanceImplementation ExampleReferences
15NIMS Implementation Activities for Hospitals and Healthcare Systems NIMS Implementation Activities have seven categories:Organizational Adoption of NIMSCommand and ManagementPreparedness PlanningPreparedness TrainingPreparedness ExercisesResource ManagementCommunication and Information Management
16NIMS Implementation Elements Organizational Adoption Element 1– Adoption of NIMSAdopt NIMS throughout the organizationImplementation Guidance:Plan for full implementationA “Phased In Approach”Hospitals should develop a plan, strategy and timeline to implement the elementsIt can be implemented over time!!! Not immediate or all at once!NBHPP outlines implementation elementsExample: All 17 elements are included in the hospital’s Emergency Management Program (EMP)The implementation of NIMS into the organization can be done over a period of time, could be 1, 2, or five years. The NIMS guidance states that hospitals should have a plan for implementation. This is good news, hospitals can implement the mandated elements (mandated by HRSA) first, and then develop a strategy and timeline to phase in the rest of the elements!
17NIMS Implementation Elements Command and Management Element 2 – Incident Command SystemManage all emergency incidents, exercises and preplanned events in accordance with ICSMust includeIncident Action Planning (IAP)Common communication plansAdopting HICS will ensure element complianceExample: Emergency Operations Plan (EOP) explains the use of ICS, IAP and common communication planning
18NIMS Implementation Elements Command and Management Element 3 – Multiagency Coordination SystemDevelop and coordinate connectivity capability with the HCC and the local ICP, 911 centers, EOCs and the State EOC and others, if applicableImplementation Guidance:Once local/regional MAC is established, hospitals should participate in collaborative planningExercises and training should be conductedExample:The EOP demonstrates the management and coordination between the HCC and multiagency coordination system entities
19NIMS Implementation Elements Command and Management Element 4 – Public Information SystemImplements plans to communicate through a JIS or JICImplementation Guidance:Hospital should identify at least one PIO, representative or spokesperson responsible for media and public infoEstablish pre-event working relationships with local media, emergency management, law enforcement, public health, EMS etc.Example:The EOP explains the management of public info with partners
20NIMS Implementation Elements Preparedness Planning Element 5 – NIMS Implementation TrackingHospitals and healthcare systems will track NIMS implementation annually as part of the EMPImplementation Guidance:Hospital must self certify complianceDesignate a NIMS implementation designeeExample: The hospital will track implementation activities annually with a goal of improving emergency management capability
21NIMS Implementation Elements Preparedness Planning Element 6 – Preparedness FundingDevelop and implement a system to coordinate hospital preparedness funding to employ NIMS across the organizationImplementation Guidance:Collaborate with state and local government and hospital associations to identify and obtain preparedness fundingState Department of HealthState Office of Homeland SecurityState Office of Emergency ManagementLocal public healthLocal emergency management
22NIMS Implementation Elements Preparedness Planning Element 6 – Preparedness Funding (continued)Example: The EMP includes information on local, state and federal preparedness grants received and deliverables to be achieved
23NIMS Implementation Elements Preparedness Planning Element 7 – Revise and Update PlansRevise EOP and Standard Operating Procedures (SOPs) to incorporate NIMSPlanningTrainingResponseExercisesEquipmentEvaluation and corrective actionsImplementation Guidance and Example:The EMP work plan reflects status of revisions to EOPs
24NIMS Implementation Elements Preparedness Planning Element 8 – Mutual Aid Agreements/MOUsParticipate in and promote interagency mutual aid agreements (public and private sector and NGOs)Implementation Guidance:Establish mutual aid agreements/MOUs with:Neighboring hospitals/healthcare systemsPublic health departmentsHazMat Response TeamsLocal Fire and Law EnforcementArea pharmaciesMedical supply vendorShare agreements with local emergency management prior to an incident occurring
25NIMS Implementation Elements Preparedness Planning Element 8 – Mutual Aid Agreements (Continued)Example:EMP documentation includes information supporting any mutual aid agreements and/or MOUs that the facility has
26NIMS Implementation Elements Preparedness Training Element 9 – IS-700: NIMS: An IntroductionComplete IS-700Implementation Guidance:IS-700 should be completed by hospital personnel in a leadership role in emergency preparedness, incident management, filling ICS/HICS roles and/or emergency responsePhased in trainingTrain others as indicated (MDs, RNs, others)Example: The EMP training records track completion of IS-700.
27NIMS Implementation Elements Preparedness Training Element 10 – IS-800.A: NRPComplete IS-800Implementation Guidance:IS 800 should be completed by personnel whose primary responsibility is emergency managementHospital must track trainingExample:Emergency preparedness program training records track completion of IS 800 or equivalentTraining by individual(s) responsible for the hospital’s emergency management program
28NIMS Implementation Elements Preparedness Training Element 11 – ICS 100 HC and 200 HCComplete ICS 100 and 200 training or equivalent coursesImplementation:IS 100: Completed by hospital personnel that would have a direct role in emergency preparedness, incident management and/or designated to fulfill ICS rolesIS 200: Completed by personnel whose primary responsibility is emergency managementIncluding middle management and administrationPersonnel designated to fulfill ICS roles
29X Emergency Management Training Requirements for Hospital Personnel Training to be completed by August 31, 2007Recommended Levels of Training for Hospital Personnel*IS or equivalentIS or equivalentIS or equivalentIS or equivalentIS 700or equivalentIS or equivalentHospital personnel who are likely to assume an ICS position in the Hospital Command Center or have a primary responsibility for emergency managementXEmergency Program ManagerHospital Emergency Preparedness Committee Members/persons responsible for the Emergency Management Plan* References: 1) NIMS Integration Center, NIMS Alert: NIMS Implementation Activities for Hospitals and Healthcare Systems, September 12, ) Health Resources and Services Administration, National Hospital Bioterrorism Preparedness Program, Fiscal Year 2005 Continuation Guidance, HRSA Announcement Number 5-U3R
30NIMS Integration Center Required training resourcesEmergency Management InstituteSelf-developed/State certified courses (equivalent courses)Center for HICS Education and TrainingFor questions or correspondence on NIMSNIMS Integration Center
31NIMS Implementation Elements Preparedness Exercises Element 12 – Training and ExercisesIncorporate NIMS/ICS into internal and external local, regional and state emergency management training and exercisesImplementation Guidance:Include NIMS and ICS into trainings and exercisesReview plans with staff to ensure competencyExample: The EMP documentation reflects the use of NIMS/ICS
32NIMS Implementation Elements Preparedness Exercises Element 13 – All-Hazards Exercise ProgramParticipate in all-hazards exercises with response partnersImplementation Guidance:Participate in local, regional and/or state multidiscipline/agency exercises 2/year to every 2 years.Exercise (drills, tabletops, functional or full-scale)Internal and external communicationsReceiving, triage, treatment and transfer of mass casualtiesProgress of casualties through the systemResource managementSecuritySpecialty lab testingSite/facility safetyExample: EMP documents reflects participation
33NIMS Implementation Elements Preparedness Exercises Element 14 – Corrective ActionsHospitals will incorporate corrective actions into response plans and proceduresImplementation Guidance:After exercises, develop a corrective action reportActions to correct the issue/deficiencyResponsible person/group to implement the actionDue date for completionIncorporate correction into P&PExample: EMP documents a corrective action process
34NIMS Implementation Elements Resource Management Element 15 – Response InventoryMaintain an inventory of organizational response assetsImplementation Guidance:Determine emergency par levels for supplies and equipmentConsider stockpilingDevelop MOUs for supply and resupplyExample: EMP documentation includes a resource inventoryMedical/surgical suppliesPharmaceuticalsPPEEquipmentStaffingEtc.
35NIMS Implementation Elements Resource Management Element 16 – Resource AllocationAs permissible, incorporate national standards and guidance into acquisition programsImplementation Guidance:As possible, establish common equipment, communications and data interoperability resources with other local response partnersExample: EMP emphasizes interoperability
36NIMS Implementation Elements Communications and Information Management Element 17 – Standard and Consistent TerminologyApply standard and consistent terminology, in plain English standardsImplementation Guidance:Establish common language consistent with local emergency management, public safety and public healthUse plain language (internal Emergency Codes OK)Example: EMP emphasizes the use of plain English by staff during emergencies
37Section Summary NIMS Activities for Hospitals and Healthcare System Include 17 elements of activitiesAdopting these elements will improve a hospital’sPreparednessResponseRecoveryMandated elements by August 31, 2007:Training of selected key personnel inICS 100 HC and 200 HCIS 700: NIMSIS 800: NRP
40How did HICS evolve and why is it important to your hospital? Origins of HICSHow did HICS evolve and why is it important to your hospital?
41From HEICS to HICSInception of HEICS in 1980’s with 2 revisions in 1990’sOver 6000 hospitals across the country utilize HEICS as their response modelObvious needs surfaced pre- and post 9/11All hazards approachCoordinated, community planning
42HEICS IV Project Key concept: Revision of previous models Incident Management System for:Daily operationsPreplanned eventsNon-emergent situationsA systems approach to managing an incidentHEICS became HICSNot just for emergencies anymore
43HEICS IV Project Intent and Objectives Maintain the fundamental conceptsPredictable chain of commandModular and scalable to the incidentPosition accountabilityCommon languageUse the Incident Command System (ICS) principles and practicesICS adapted to the unique hospital setting
44HEICS IV Project Intent and Objectives Intended Outcomes Incorporate current emergency management practicesAddress NIMS compliance issuesIntegrate CBRNE eventsMaintain system scalability for allDevelop core materialsAddress instructor qualificationsScaleable: hospitals both rural and urban; teaching, specialty;Use in planning, response and recoveryPromote alignment with community partners through incorporation of NIMS guidelines
45HEICS IV Project Team National Working Group Ex-Officio Members Hospital subject matter expertsEx-Officio MembersAHA, JCAHO, DHS, DHHS, ASHE, NIC, EMI, HRSASecondary Review GroupSubject matter experts from the healthcare communityExecutive GroupCalifornia EMS Authority and Contract Support GroupContract Support GroupER One Institute at the Washington Hospital CenterKaiser National Healthcare Continuity Management
46What’s New in HICS? All-hazards and ‘systems’ approach A management toolEmphasizes preparedness efforts with community partnersScalable and adaptable for all hospitalsAssists with NIMS compliance for hospitals and healthcare systems
47What’s New in HICS?Uses the Incident Command System (ICS) principles and practicesICS adapted to the unique hospital settingApproved by the NIMS Integration Center (NIC), HRSA and Joint CommissionFIRESCOPE ‘s inception in the 197os was a direct response to the 1907 fires season in Southern California. In 1971, Congress directed the US Forest Services to design a system to respond to these events. US Forest Service joined with CA OES, CDF and the fire depts. of Santa Barbara, LA City, LA County and , Ventura to develop FIRESCOPE.
48New HICS Products HICS Guidebook Incident Management Team Chart Replaces the HEICS Organizational ChartRevised for consistency with NIMSUpdated Job Action SheetsIncident Planning and Response GuidesUpdated HICS FormsConsistent with NIMS / Standard ICSHICS Educational MaterialsNIMS Implementation Activities
49Why Is HICS Important to Your Hospital? Comply with regulatory standards and nongovernmental guidelinesThe Joint CommissionEnvironment of Care 4.10Health Resources and Services Administration Cooperative AgreementsNIMS compliance and Training requirementsEmergency Medical Treatment and Active Labor ActHealth Insurance Portability and Accountability ActThe Joint Commission has stated that while there is no mandate to implement the 17 NIMS activity elements for JCAHO accreditation, however, if a hospital does choose to implement the activities and elements, then the hospital will be in line with the emergency management requirements of the Joint Commission for accreditation (per John Fishbeck at JCAHO)
50Why Is HICS Important to Your Hospital? Comply with regulatory standards and nongovernmental guidelinesOSHA29 CFR Part Hazardous Materials RegulationsCenters for Medicare and Medicaid ServicesNational Fire Protection Association (NFPA 1600)Standard Healthcare facilitiesStandard 1600 – Disaster/Emergency ManagementAmerican Society for Testing and Materials (ATSM)F-1288 – Guide for Planning and Response to an MCISuperfund Amendments and Reauthorization Act
51Why Is HICS Important to Your Hospital? Assists in coordinating the hospital’s planning and response efforts and actionsSets direction and goals in initial effortsAssists with Incident Action PlanningMission focusedManages the incident using the Incident Command SystemDefines roles and responsibilitiesFacilitates community responder communication and mutual aid
52Why Is HICS Important to Your Hospital? Facilitates coordination with partnersLocal and community (sister or “buddy”) hospitals and healthcare systemsRegional Hospital Coordination CentersPublic safety agenciesLocal Emergency ManagementNongovernmental organizations (NGO)
53Why Is HICS Important to Your Hospital? Serves as the foundation for your Emergency Operations PlanHICS is NOT the EOPHICS is a system management tool
54HICS Resources HICS Guidebook and materials California Emergency Medical Services Authority website at:The Center for HICS Education and Training
55Section SummaryHICS is useful for daily operations, preplanned events and non-emergent situationsHICS uses the Incident Command System (ICS) principles and practicesICS adapted to the unique hospital settingHICS complies with regulatory mandatesAssists in coordinating the hospital’s internal and external planning, response and recovery
59The HICS Guidebook Explains the critical components of HICS Describes the use of HICS products and materialsAssists with emergency management planningGuide for:Hospital planners and respondersCommunity responders to understand and integrate hospitals into larger response
60The HICS Guidebook The Guidebook is NOT The definitive text on emergency preparednessDesigned to comprehensively teach the principles of incident commandNot the Emergency Management or Operations Plan
61The HICS Guidebook Chapter 2 - Principles of Incident Command Chapter 1 - Introduction to HICSHistory of the HEICS IV Project and transition to HICSScope and applicabilityHEICS IV Project TeamChapter 2 - Principles of Incident CommandHistory of ICSIncident management functionsIncident action planning process
63The HICS Guidebook Chapter 5 - Hospital Incident Command System Incident Management TeamCommandOperationsPlanningLogisticsFinance / AdministrationIncident Command Principles and Practice
64The HICS Guidebook Chapter 6 - Life Cycle of an Incident Alert and NotificationSituation Assessment and MonitoringEmergency Operations Plan ImplementationsEstablishing the Hospital Command CenterBuilding the ICS StructureIncident Action PlanningCommunications and CoordinationStaff Health and SafetyOperational ConsiderationsLegal and Ethical ConsiderationsDemobilizationSystem RestorationResponse Evaluation and Organizational Learning
65The HICS Guidebook Appendices A: Incident Planning Considerations B: HICS Incident Management Team ChartC: Using the Job Action SheetsD: Using the HICS FormsE: HEICS to HICS: Implementation StepsF: Potential Candidates for HICS Command Positions
66The HICS Guidebook Appendices G: HEICS III to HICS Position Crosswalk H: Working with the Scenarios, Incident Planning and Response GuidesI: NIMS Implementation Activities for Hospitals and Healthcare SystemsJ: Recommended ResourcesK: HEICS IV revision project organization
67The HICS Guidebook Educational materials Module based Power Points presentations highlighting key HICS conceptsPrint materials to accompany the power points27 scenarios to use to assist with exercise planning14 External scenarios13 Internal scenarios
68The Future of HICS HICS is a living document and system Grows and evolves as practices and hospital needs changeModifications made as lessons are learnedAdapted for your hospital’s unique needsContinue to advance hospital preparedness and emergency management standardization
69Section Summary The HICS Guidebook provides The critical components of HICSAn overview of Emergency Management principlesGuidance on how to use the HICS products and materials
71Incident Management Team Building theIncident Management Team
72HICS IMTThe IMTDepicts hospital management functions and how authority and responsibility is distributedEach of the 5 management functions is color codedCommand (white or grey)Operations (red)Planning (blue)Logistics (yellow)Finance/Administration (green)
73HICS IMT HierarchyDivisions not in HICS, but is used by ICS, mainly Fire Agencies.Strike Teams and Task Forces are more commonly used in hospitals, while single resources are not commonly used.Note: Divisions and Groups are used in ICS but not reflected in the HICS IMT
74IMT TitlesThe IMT titles are distinct and standardized. This serves three important purposes: **Allows for filling IMT positions with the most qualified persons and not by rankAssists with requesting outside resources to staff these positionsAssists with clarifying the activities undertaken by specific personnel
75IMT Hierarchy The Incident Commander Command Staff Is the only position always activated for every incident**Has overall responsibility to manage the incidentCommand StaffTitle: OfficerPositions:Public Information OfficerSafety OfficerLiaison OfficerMedical/Technical Specialists
76IMT Hierarchy General Staff**: Organizational Component: Section Title: Section ChiefRole: Responsible for major functional areas of the incidentIMT Positions:OperationsPlanningLogisticsFinance/Administration
77IMT Hierarchy Deputy Chief Role: Assistant Role: The individual assuming the Deputy role will assist the Command Staff, Section Chiefs or Branch Directors** by performing delegated job activities or tasks as outlined by that JASAssistant Role:A subordinate to a Command Staff or Section Chiefs who performs technical capabilities and responsibilitiesThey may also be assigned to a Unit Leader as situational needs dictate and resources allow
78IMT Hierarchy Branches: Title: Branch Director Role: IMT Positions: Branches can be establishedGeographically or functionally**When the number of Divisions or Groups exceed the span of control for the Section Chief*Branches may also be established*In multi-disciplinary incidentIn multi-jurisdictional incidentsVery large incidentsIMT Positions:Specific to the Section’s dutiesExample:Medical Care Branch Director in OperationsService Branch Director in Logistics
79IMT Hierarchy Divisions/Groups: Title: Division Supervisor Role: Division: Divide the incident geographicallyExample: first floor and second floorGroup: Divide the structure into functional areas of operation by the resources to perform the functionIMT Positions:Divisions and Groups are not commonly used in the hospital settingDivisions and Groups are NOT REFLECTED in the HICS IMT
80IMT Hierarchy Units: Title: Unit Leader Role: Functional responsibility for a specific incident activity under a Section and BranchIMT Positions:Specific to the Branch’s dutiesExample:Inpatient Unit Leaders in the Medical Care Branch in the Operations SectionSituation Unit Leader in the Planning SectionLabor Pool and Credentialing Unit in the Support Branch in the Logistics Section
81IMT Hierarchy Single Resources, Strike Teams, Task Forces Title: LeaderRole:Single Resources:An individual or piece of equipment with its personnel complement (i.e., perfusionist)A crew or team of individuals with a identified supervisorStrike Teams:A set number of similar resources (i.e., burn RNs)Task Forces:A combination of mixed resources (i.e., RNs, MDs, Techs, Secretaries)IMT Positions:These are NOT REFLECTED on the HICS IMTCan be employed by the hospital as dictated by the incidentThese teams report to the Unit Leader
82Building the IMTThe Incident Commander is responsible for building the Incident Command TeamThe IMT is built according to the incident:Scope and magnitude of the eventPotential/real impact to the hospitalHospital sizeAvailable resourcesSpecial response needs (i.e., HazMat, biological, legal, IT)
83Building the IMTEvery incident requires certain management functions be performedThe incident/problem must be evaluatedA plan must be developed to address the problemsThe necessary resources must be assignedOutcomes and effectiveness must be evaluatedManagement by objectives is essential for successful Incident Action Planning**, response and recovery
84Building the IMTThe IC should appoint properly trained persons to critical Command and General Staff positions
85Building the IMT Once appointed: IMT position titles are standardized Section Chiefs and Branch Directors staff their own sectionsIMT position titles are standardizedDescribe the position’s role and mission rather than the personAllows the position to be filled by the most qualified rather than by seniorityFacilitates requests for outside qualified personnel
86Building the IMT The IMT reflects a reasonable “Span of Control” Definition: The number of individuals or resources one supervisor can effectively manage**Ratio of 3-7 reporting elements per 1 supervisorThe IMT structure does not exactly mirror the daily administrative structureThis is purposefulReduces role and title confusion duringthe response**HICS IMT Crosswalk suggests position assignments
87IMT Crosswalk Incident Commander Planning Section Chief Logistics Operations SectionChiefFinance/AdministrationPublic InformationOfficerLiaisonMedical/TechnicalSpecialistSafetyŸHospital Administrator/Administrator On-CallNursing SupervisorChief Executive OfficerChief Operating OfficerChief Medical OfficerChief Nursing OfficerEmergency Management CoordinatorSafety DirectorSecurity ChiefBuilding EngineerEmergency ManagementCoordinatorRadiation Safety OfficerEmployee HealthInfection ControlRisk ManagementIndustrial HygienistInfectious DiseaseEpidemiologyChief of StaffChief of PediatricsNuclear MedicineHealth PhysicistStructural EngineerOutpatient Services AdministratorChief of TraumaPrimary Care DirectorBehavior Health DirectorLegalRisk ManagerPoison Control DirectorIT/IS DirectorHospital Public Information OfficerMarketing DirectorPatient RelationsChief Information OfficerCommunity RelationsEmergency Management CoordinatorStrategic PlanningVP of AdministrationHuman Resources DirectorNursing DirectorVP of FacilitiesChief Procurement OfficerSupport Services DirectorSupply DirectorFacilities DirectorWarehouse DirectorChief Finance OfficerVP of FinanceVP of Business ServicesController/ComptrollerHospital Administrator/Admintrator on CallChief Engineer
88Building the IMTPositions appointed to meet the incident needs do not have to be sequential from the top down*Appoint those positions to meet the immediate needs of the incidentExample……..
89Building the IMT - Example Situation: It is 4:00 am and a large fire erupts in the laboratory, located very close to two patient care areas with a high census.IC activates IMT positions needed immediately!I ensure safety of the patients, staff and facilityI will oversee the medical careExample: In the case of aI ensure HVAC, Med Gases and assess damageI am needed to call in additional staff to assist with evacuation
90IMT CommunicationsCommunication and information-sharing in the IMT should occur:Up and down the chain of commandAcross Sections to the appropriate Section/Branch/Unit**Information should be displayed on status boards and easily accessedCommunications should be documented for accountability and archivingCommunication can be formal and informal, people can talk among the branches sharing information.
91Section SummaryIncidents may be different but the IMT fundamentals remain the same:Positions activated and structure of IMT meet the needs of the incidentPositions are filled by qualified and trained personnelBased on qualifications rather than by seniorityThe HICS IMT has a defined hierarchy and chain of command and reporting
94Command Command functions Incident Commander in charge Maintain overall management of the incidentSet the incident objectives and prioritiesDevise and approve strategiesEnsure mission completionIncident Commander in chargeCommand consists of:Command staffGeneral staff
96Incident Commander Mission: Organize and direct the Hospital Command Center (HCC). Give overall strategic direction for hospital incident management and support activities, response and recovery. Authorize total facility evacuation if warrantedThe first Incident Commander is responsible until the authority is delegated to another person**
97Incident Commander Duties: Ensure incident safety * Initiate HICS and activation of the HCCDetermine scope and magnitude of event and potential impacts on the facilityDetermine and activate appropriate IMT positionsInitiate and approve the IAPProviding information services to internal and external stakeholders*Liaison with Governing Board and other organizations*
98Public Information Officer Mission:Serve as the conduit for information to internal and external stakeholders**, including staff, visitors and families, and the news media, as approved by the Incident CommanderDuties:Determine parameters of information release from the ICDetermine any restrictions in content (sensitive materials)Collaborate with local community officials (JIC) on risk communication messages for consistent contentMaintain contact with Situation Unit Leader for current information and facility statusSchedule regular media briefings and press releasesReport to: Incident Commander
99Safety Officer Mission: Duties: Report to: Incident Commander Ensure safety of staff, patients, and visitors, monitor and correct hazardous conditions. Have authority to halt any operation that poses immediate threat to life and healthDuties:Determine safety risks of the incident to personnel, the hospital facility, and the environmentInitiate corrective/protective actions for safety issuesReport to: Incident Commander
100Liaison Officer Mission: Duties: Reports to: Incident Commander Function as the incident contact person in the Hospital Command Center for representatives from other agenciesDuties:Is the primary contact for supporting agencies and organizations assisting at an incident but not participating in the HCC/ICS structure**Establish contacts with liaison counterparts in each assisting and cooperating agency (including other hospitals, RHCCs, EOCs and others)Update governmental liaisons on the hospital status and responseMake facility needs and requests for assistance and resourcesReports to: Incident Commander
101Medical/Technical Specialists The Specialist Position is new and unique to HICSA category of personnel w/specialized expertiseActivated based on situational needPrimarily are consultants but can have delegated authorityCan have more than one in activated at a timeMay report to any position in the IMTHospitals can create other categories as needed
102Medical/Technical Specialists Specialist RolesBiological/Infectious diseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal affairsRisk managementMedical StaffPediatric CareMedical Ethicist** Others can be developed as needed by thehospital
103Medical/Technical Specialists Mission:Advise the Incident Commander and/or assigned Section on issues related to emergency response in their area of expertiseDuties:May be assigned as technical advisor in the HCCMay be assigned to advise and oversee specific hospital operationsExample: Decontamination operations during a chemical exposure situation
104Section SummaryThe Incident Commander is the only position that will ALWAYS be activatedThe Incident Commander hasoverall responsibility for:Management of the IncidentActivities within the HCCContinuing as IC until authority is delegated to anotherThe Command Staff consists of:PIOLiaisonSafety OfficerMedical/Technical Specialists
109Operations Section Section Mission: Lead by a Section Chief Manage tactical operations**Direct all tactical resourcesCarry out the mission and Incident Action PlanLead by a Section ChiefLargest section of resources to marshal and coordinateTactical resources are classified**:AssignedAvailableOut-of-Service
110Operations Section The Section includes: Staging Area Medical Care BranchInfrastructure BranchHazMat BranchSecurity BranchBusiness Continuity Branch
111Operations Section Chief Mission:Develop and implement strategy and tactics to carry out the objectives established by the Incident Commander. Organize, assign, and supervise Staging, Medical Care, Infrastructure, Security, Hazardous Materials, and Business Continuity Branch resourcesDuties:Appoint Section personnel as indicated by eventConduct Section briefings, update Unit LeadersMaintain current status of all areas in the SectionCommunicate with and advise the IC on Section issues/needs
112Operations Section Chief Supervises:Staging ManagerMedical Care Branch DirectorInfrastructure Branch DirectorHazMat Branch DirectorSecurity Branch DirectorBusiness Continuity Branch Director
113Staging Manager Mission: Supervises: Organize and manage the deployment of supplementary resources, including personnel, vehicles, equipment, supplies, and medicationsSupervises:Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging Team
114Staging Manager Duties: Coordinate delivery of needed resources to requesting areaOnce resources are acquired by Logistics, they are then staged with the Staging ManagerEstablish a staging area in a central locationArea must be large enough to “stage” resourcesWorks closely with the Logistics SectionIf staging area resources become too great, appoint appropriate Team Leaders
115Medical Care Branch Director Mission:Organize and manage the delivery of emergency, inpatient, outpatient, and casualty care, and clinical support servicesDuties:Addresses provision of acute AND continuous careWorks closely with Logistics Section to ensure resource acquisitionWorks closely with Staging Manager for delivery of resources to areas
116Medical Care Branch Director Supervises:Inpatient Unit Leader (all inpatient units)Outpatient Unit Leader (all outpatient services)Casualty Care Unit Leader (Emergency Dept.)Mental Health Unit LeaderClinical Support Unit Leader (Lab, Diagnostic Imaging, Pharmacy, Morgue, Blood Donor)Patient Registration Unit LeaderReports to the Operations Section Chief
117Infrastructure Branch Director Mission:Organize and manage the services required to sustain and repair the hospital’s infrastructure operationsDuties:Maintains overall facility operations and normal operating capacityIdentify and fix utility service-delivery failuresCoordinate the acquisition of parts or contractors with the Logistics SectionAssign a strike team to address damage to the facility as needed
118Infrastructure Branch Director Supervises:Power/Lighting Unit LeaderWater/Sewer Unit LeaderHVAC Unit LeaderBuilding/Grounds Unit LeaderMedical Gases Unit LeaderMedical Devices Unit LeaderEnvironmental Services Unit LeaderFood Services Unit Leader (for inpatients)Reports to Operations Section Chief
119HazMat Branch Director Mission:Organize and direct hazardous material incident response activities: detection and monitoring; spill response; victim, technical, and emergency decontamination; and facility and equipment decontaminationDuties:Oversee the operations involving a hazmat eventDecontamination of victims, staff, facilitySafe and appropriate use of PPEClean up operationsCollaborates closely with Medical Care Branch Director
120HazMat Branch Director Supervises:Detection and Monitoring Unit LeaderSpill Response Team Unit LeaderVictim Decontamination Unit LeaderFacility/Equipment Decontamination Unit LeaderReports to Operations Section Chief
121Security Branch Director Mission:Coordinate all of the activities related to internal and external personnel and facility securityDuties:Implement facility security measuresEnsure security and access control of the HCCLiaison with responding law enforcement personnelOversee search and rescue operations for the facility
122Security Branch Director SupervisesAccess Control Unit LeaderCrowd Control Unit LeaderTraffic Control Unit LeaderSearch Unit LeaderLaw Enforcement Interface Unit LeaderReports to the Operations Section Chief
123Business Continuity Branch Director Mission:Ensure business functions are maintained, restored or augmented to meet designated Recovery Time Objectives (RTO) and provide limited interruptions to continuity of essential business operationsCan be activated immediately or as needed during the responseDuties:Facilitate the acquisition of and access to essential recovery resources, including business recordsSupport Branches with relocation to alternate business sitesCoordinate IT services with Logistics SectionAssist Branches and impacted areas to restore normal operationsBusiness continuity is an area that is greatly overlooked. Business recovery was once the arena only of the IT departments. However, the resumption on “normal” services and recovery of the facility is essential for community health and facility financial viability. It is very important that business continuity be addressed during the response phase and managed throughout recovery
124Business Continuity Branch Director Supervises:Information Technology Unit LeaderMission: Ensure IT business functions are maintained, restored or augmentedWorks closely with Logistics Section IT/IS UnitService Continuity Unit LeaderMission: Ensure business/clinical/ancillary service functions are maintained, restored or augmented
125Business Continuity Branch Director Supervises:Records Preservation Unit LeaderMission: Ensure vital business/medical records are maintained and preservedBusiness Function Relocation Unit LeaderMission: Ensure business functions are moved to alternative work sites
126Section Summary The Operations Section is responsible for All tactical operations,**The tactical objectives and organizationDirecting all tactical resourcesOperations Section is led by a ChiefOperations Section positions are activated as needed by the incident
129Logistics Provides support to other sections Acquires resources from internal and external sourcesActivate existing MOUs, contracts and vendor agreementsEmploys standard and emergency procurement and contracting proceduresWith Liaison, links to local EOC and/or Regional Hospital Coordination Center for resource requests
130Logistics and Operations Logistics and Operations are closely linked and must work collaboratively togetherLogistics Section is the “getters”Operations Section is the “doers”Scope and Responsibilities overlapLogistics Supply Unit and Operations’ Infrastructure BranchLabor Pool and Credentialing Unit and Staging Manager– Personnel Team LeaderThese divisions might seem duplicative, but have been divided in the HICS IMT. Logistics is the “Radar O’Reilly” of the response, acquiring the resources needed to respond. The resources are then provided to the Operations Section to use.The examples of logistics and ops in this slide are to highlight the roles in each of the situations. #1: Scenario: the HVAC has failed. The Supply Unit and Facilities Units would work to get the needed items, or to contact the proper contractor to repair the HVAC. The Infrastructure Branch would oversee and participate in the actual repairs. #2: Scenario: Outbreak of infectious disease in the community with large number of victims over a prolonged period of time. Because of the size of the incident and the number of resources required, the Operations Section has activated their Staging Manager, including the Personnel Team Leader. The Labor Pool role will be to acquire the personnel, according to the needs of the departments and areas, and also credential volunteers. When the personnel arrives at the hospital, they would be sent to the Staging area to await assignment. In a scenario where the staging area is NOT activated, then the Labor Pool and Credentialing Unit would procure the personnel resources AND deploy those resources to the needed areas.
131Logistics Section Chief Mission:Organize and direct those operations associated with maintenance of the physical environment and with the provision of human resources, materiel, and services to support the incident activities. Participate in Incident Action PlanningDuties:Oversee the acquisition of resourcesMaintain current status of all areas in the section
132Logistics Section Chief Supervises:Service Branch DirectorSupport Branch DirectorReports to the Incident Commander
133Service Branch Director Mission:Organize and manage the services required to maintain the hospital’s communication system, food and water supply for staff, and information technology and systemsOversees:Communications Unit LeaderIT/IS Unit LeaderStaff Food and Water Unit Leader
134Service Branch Unit Leaders Communications Unit LeaderMission: Organize and coordinate internal and external communications connectivityIT/IS Unit LeaderMission: Provide computer hardware, software and infrastructure support to staffCoordinates closely with Operations Section Business Continuity Branch, IT UnitStaff Food and Water Unit LeaderMission: Organize food and water stores and prepare for rationing during periods of anticipated or actual shortageCoordinates closely with Operations Section Infrastructure Branch, Food Services Unit
135Support Branch Director Mission:Organize and manage the services required to maintain the hospital’s supplies, facilities, transportation, and labor pool. Ensure the provision of logistical, psychological, and medical support of hospital staff and their dependents.Oversees:Employee Health and Well-Being Unit LeaderFamily Care Unit LeaderSupply Unit LeaderFacilities Unit LeaderTransportation Unit LeaderLabor Pool and Credentialing Unit Leader
136Support Branch Unit Leaders Employee Health and Well Being Unit(Known as the “Medical Unit” in ICS**)Mission:Provide medical screening, evaluation and follow-up of employees who are assigned to the incident**Ensure the availability of medical care for injured or ill staffEnsure the availability of behavioral and psychological support services to meet staff needs during and following an incident.Coordinate mass prophylaxis/vaccination/immunization of staff, if required. Coordinate medical surveillance program for employeesFamily Care UnitEnsure the availability of medical, logistic and mental health and day care for the families of staff members. Coordinate mass prophylaxis/vaccination/immunization of family members if required
137Support Branch Unit Leaders Supply UnitMission:Acquire, inventory, maintain, and provide medical and non-medical care equipment, supplies, and pharmaceuticalsFacility UnitOrganize, manage and support building systems, equipment and supplies. Ensure proper cleaning and disinfection of hospital environment.
138Support Branch Unit Leaders Transportation UnitMission:Organize and coordinate the transportation of all ambulatory and non-ambulatory patients. Arrange for the transportation of human and materiel resources within or outside the facilityLabor Pool and Credentialing UnitCollect and inventory available staff and volunteers at a central point (Labor Pool) for assignment by the Staging Officer. Maintain adequate numbers of both medical and non-medical personnel. Assist in the maintenance of staff moraleCoordinates closely with Operations Section Staging Manager
139Section Summary The Logistics Section supports the resource requirements of the responseLogistics Section has two branches:SupportServiceThe Logistics Section is led by a Chief**Logistics works closely with the Operations Section
142Planning Section Section Mission: Lead by a Section Chief Collect, evaluate, and disseminate incident action information and intelligence to Incident Commander*Prepare status report and display various informationDevelop the Incident Action Plan (IAP)Lead by a Section Chief
143Planning Section Chief Mission:Oversee all incident-related data gathering and analysis regarding incident operations and assigned resources, develop alternatives for tactical operations, conduct planning meetings, and prepare the Incident Action Plan (IAP) for each operational periodDuties:Ensure distribution of critical information/dataCompile scenario projections from all Section Chiefs and effect long range planningDocument and distribute the facility action planConduct Section briefings, update Unit LeadersMaintain current status of all Sections
144Planning Section Chief Supervises:Resources Unit LeaderSituation Unit LeaderDocumentation Unit LeaderDemobilization Unit Leader
145Resource Unit Leader Mission: Oversees: Maintain information on the status, location, and availability of personnel, teams, facilities, supplies, and major equipment to ensure availability of use during the incident. Maintain a master list of all resources assigned to incident operationsOversees:Personnel Tracking LeaderMateriel Tracking Leader
146Tracking Leaders Personnel Tracking Leader Materiel Tracking Leader Mission:Maintain information on the status, location, and availability of on-duty staff and volunteer personnelMateriel Tracking LeaderMaintain information on the status, location, and availability of equipment and supplies within the hospital inventory and additional materiel received from outside agencies in support of the incident
147Situation Unit Leader Mission: Collect, process, and organize ongoing situation information; prepare situation summaries; and develop projections and forecasts of future events related to the incident. Prepare maps and gather and disseminate information and intelligence for use in the Incident Action Plan (IAP)Focus is on current and future situation managementWrites and maintains situation updates and IAPsMaintains the HCC Status BoardsThis role and position is heavy clerical and paper focused, and must be staffed with adequate numbers of personnel to assist in performing functions.
148Situation Unit Leader The Situation Unit is very busy! Staff with lots of clerical assistanceStaff with people to monitor TV, mediaNetworks closely with the Liaison OfficerSupervises:Patient Tracking LeaderBed Tracking Leader
149Tracking Leaders Patient Tracking Leader: Bed Tracking Leader: Mission:Monitor and document the location of patients at all times within the hospital's patient care system, and track the destination of all patients departing the facilityBed Tracking Leader:Maintain information on the status, location, and availability of all patient beds, including disaster cots and stretchers
150Documentation Unit Mission: Duties: Maintain accurate and complete incident files, including a record of the hospital’s/HCC response and recovery actions and decisions; provide duplication services to incident personnel; and file, maintain, and store incident files for legal, analytical, and historical purposesDuties:Collects, organizes and archives all response and recovery documentation and paperwork (forms)Assists in writing the Incident Action Plan (IAP)Assists in preparing the After-Action Report and Corrective/Improvement Plan based on lessons learned**Works closely with the Situation Unit Leader
151Demobilization Unit Mission: Duties: Develop and coordinate an Incident Demobilization Plan that includes specific instructions for all staff and resources that will require demobilizationDuties:Responsible for drafting demobilization and system/business recovery plan for the incident approved by the Command Staff/Incident CommanderDemobilization starts EARLY in the response!
152Section Summary The Planning Section is responsible for: Collecting, evaluating and disseminating incident situation information and intelligence to the HCCMaintaining resource statusDeveloping the Incident Action Plan (IAP) **Archiving all response and recovery documentationAssisting with development of the After-Action ReportThe Planning Section is led by a Chief
155Finance/Administration Section Section Mission:Account for costs incurred from the outset of the responseAccount for expenses from multiple cost centersMonitor, track and report personnel, time, repair, purchase, and replacement expenses and lost revenueModify or expand daily (usual) accounting practices to meet the needs of the incident and outlined in the EOPSection led by a Chief
156Finance/Administration Section Chief Mission:Monitor the utilization of financial assets and the accounting for financial expenditures. Supervise the documentation of expenditures and cost reimbursement activitiesDuties:Oversee the acquisition of supplies and services to carry out the medical missionSupervise the documentation of expenditures relevant to the emergency incidentDirects financial RECOVERY
157Finance/Administration Section Chief Supervises:Time Unit LeaderProcurement Unit LeaderCompensation/Claims Unit LeaderCost Unit Leader
158Time Unit Leader Mission: Responsible for the documentation of personnel time records. Monitor and report on regular and overtime hours worked/volunteeredAdjusts reports and tracking to meet the needs of the incidentTracking of altered or expanded work periods/shiftsDeveloping specialized tracking forms to capture response and recovery time
159Procurement Unit Leader Mission:Responsible for administering accounts receivable and payable to contract and non-contract vendorsInitiates emergency contractsAgreements should be already in placeConfirm existing vendors can deliver in emergenciesConfirm payment arrangementsManages purchase orders
160Compensation/Claims Unit Leader Mission:Responsible for receiving, investigating and documenting all claims reported to the hospital during the emergency incident, which are alleged to be the result of an accident or action on hospital propertyDuties:Manages claims and worker’s compensation issuesInjury/illness to staff, volunteers and visitorsShould have comprehensive line of duty death procedure to implement if neededFollow up coverage/compensation/benefits clearly outlined and shared with staff memberDefine what line of duty death is: a death of a staff or physician or volunteer member while on duty. Procedure should include information, grieving of staff and recognition of the dead person. Long term CISM may be necessary.
161Cost Unit Leader Mission: Duties: Responsible for providing cost analysis data for the declared emergency incident and maintenance of accurate records of incident costDuties:Track and pay response and recovery costsProjects lost revenuePrepares documents for state/federal reimbursement when applicableTracks paymentsPatient insurance and reimbursementGovernment
162Section Summary The Finance/Administration Section** Manages costs related to the incidentProvidesAccountingProcurementTime recordingCost analysisThe Section is led by a Chief**
165Purpose of the JASAn incident management tool to familiarize the user with critical aspects of the command position he or she is assuming.The series of action steps are intended to “prompt” the incident management team members to take needed actions related to their roles and responsibilities
166Use of the JAS HICS provides 78 Job Action Sheets In most cases only a portion of these positions will be necessary for a successful responseActivation of HICS positions may be based on:Scope and magnitude of the eventHospital sizeAvailable resourcesResponse needs
167JAS FormatThe key format considerations for each JAS are the same and include the following information:Command Title – the name of the positionMission – a brief statement summarizing the basic purpose of the jobFundamental Information Box –Date and timesHighlights reporting relationshipsRecords to whom the position is assignedLocation of the HCC or positionContact information and radio title
168OPERATIONS SECTION CHIEF JAS FormatOPERATIONS SECTION CHIEFMission: Develop and implement strategy and tactics to carry out the objectives established by the Incident Commander. Organize, assign, and supervise Staging, Medical Care, Infrastructure, Security, Hazardous Materials, and Business Continuity Branch resources.Date: Start: End: Position Assigned to: Initial:Position Reports to: Incident Commander Signature:Hospital Command Center (HCC) Location: Telephone:Fax: Other Contact Info: Radio Title:
169JAS Format Action Steps and Considerations JAS provides position action steps and considerationsActions listed by operational periodsImmediate –2 hoursIntermediate –12 hoursExtended Beyond 12 hoursDemobilization/System Recovery (New)
170JAS Format The JAS format enables users to: Document each action undertaken with initialsRecord decision and action timeframesMany action steps are common to all positionsRead the entire JASPut on position identificationNotify your usual supervisor of your HICS positionDocument using formsCoordinate with other HICS positionsInclude considerations for shift change report
171Immediate Actions – Operations Chief Immediate (Operational Period 0-2 Hours)TimeInitialReceive appointment and briefing from the Incident Commander. Obtain packet containing Operations Section Job Action Sheets.Read this entire Job Action Sheet and review organization chart (HICS Form 207). Put on position identification.Notify your usual supervisor of your HICS assignment.Determine need to appoint Staging Manager, Branch Directors, and Unit Leaders in Operations Section; distribute corresponding Job Action Sheets and position identification. Complete the Branch Assignment List (HICS Form 204).Brief Operations Section Branch Directors and Staging Manager on current situation and incident objectives; develop response strategy and tactics; outline Section action plan and designate time for next briefing.Participate in Incident Action Plan preparation, briefings, and meetings as needed; assist in identifying strategies; determine tactics, work assignments, and resource requirements.Obtain information and updates regularly from Operations Section Branch Directors and Staging Manager; maintain current status of all areas; inform Situation Unit Leader of status information.In the JASs, there are actions and activities that are common to all ICS positions. An example of a few of the actions/duties that are common actions are listed in RED above.
172Intermediate Actions – Operations Chief Intermediate (Operational Period 2-12 Hours)TimeInitialCommunicate regularly with the Incident Commander, Public Information Officer and Liaison Officer; brief regularly on the status of the Operations Section.Designate time(s) for briefings and updates with Operations Section leadership to develop or update the Section action plan.Initiate the Resource Accounting Record (HICS Form 257) to track equipment used during the response.Schedule planning meetings with Branch Directors and Staging Manager to update the Section action plan and demobilization procedures.Coordinate patient care treatment standards and case definitions with public health officials, as appropriate.Ensure that the Operations Section is adequately staffed and supplied.Coordinate personnel needs with Labor Pool & Credentialing Unit Leader, supply and equipment needs with the Supply Unit Leader, projections and needs with the Planning Section, and financial matters with the Finance/Administration Section.Ensure coordination with any assisting or cooperating agency.Intermediate actions are listed as action items. The JAS also contain reminders or prompts for the user to complete position specific forms, as noted in red above. The JAS was also written to remind of other key positions that they should be coordinating with in the HCC… as listed in the second red area above.
173Extended Actions – Operations Chief Extended (Operational Period Beyond 12 Hours)TimeInitialContinue to monitor Operations Section personnel’s ability to meet workload demands, staff health and safety, resource needs and documentation practices.Continue to maintain the Resource Accounting Record (HICS Form 257) to track equipment used during the response.Conduct regular situation briefings with Operations Section Branch Directors and Staging Manager.Address issues related to ongoing patient care:Ongoing patient arrivalBed availabilityPatient transfersPatient trackingStaff health and safetyMental health for patients, families, staff, incident management personnelFatality managementStaffingStaff prophylaxisMedicationsMedical equipment and suppliesPersonnel and resource movement through Staging AreaLinkages with the medical community, area hospitals, and other healthcare facilitiesDocumentationUpon shift change, brief your replacement on the status of all ongoing operations, issues, and other relevant incident information.The Extended actions will remind you to continue activities from the previous phases and prompt you to complete proper forms
174Demobilization/System Recovery Actions Operations Chief TimeInitialAs needs decrease, return Operations Section staff to their usual jobs and combine or deactivate positions in a phased manner, in coordination with the Demobilization Unit Leader.Coordinate patient care restoration to normal services.Coordinate final reporting of patient information with external agencies through Liaison Officer and Public Information Officer.Work with Planning and Finance/Administration Sections to complete cost data information.Debrief staff on lessons learned and procedural/equipment changes needed.Upon deactivation of your position, brief the Incident Commander on current problems, outstanding issues, and follow-up requirements.Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214) are submitted to the Documentation Unit.Submit comments to the Incident Commander for discussion and possible inclusion in an after-action report; topics include:Review of pertinent position descriptions and operational checklistsRecommendations for procedure changesSection accomplishments and issuesParticipate in stress management and after-action debriefings. Participate in other briefings and meetings as required.Demobilization/System Recovery is a new phase in HICS. Demob/Recovery can begin at any time during the response and should be considered very early in the response. The areas in blue are reminders to review the needs of your role/Section and demobilize people as needed. The JAS continues to remind you to coordinate with other sections. Upon deactivation of the position, reminds you of who to report to and submission of all documentation.
175JAS Format Documents/Tools – A listing of pertinent HICS forms this position is responsible for usingForms noted in JAS action stepsOther tools that will help them fulfill their role and responsibilitiesHospital plans, policies and proceduresTechnology toolsOther adjuncts
176Documents/Tools – Operations Chief Incident Action PlanHICS Form 204 – Branch Assignment SheetHICS Form 207 – Organization ChartHICS Form 213 – Incident Message FormHICS Form 214 – Operational LogHICS Form 257 – Resource Accounting RecordHospital emergency operations planHospital organization chartHospital telephone directoryRadio/satellite phone
177Role of Deputies and Assistants No JAS has been written for a Deputy Chief or assistantsThey work from the JAS of the position they assumeDeputy Chief:Assigned for Command or General StaffAssistant:Assigned to Unit Leaders as needed and resources allow
178JAS Use The format allows for the JASs to be used To preliminarily document actions taken during the incidentTo develop a chronology of events, problems encountered, and decisions madeUse the Operational Log (HICS Form 214) continuously to detail actions, decisions and activities
179JAS Use JASs are used continuously during the response Actions in all operational periods should be continued and monitoredJAS should transfer to your replacement and actions continuedUpon shift change or position change
180JAS CustomizationThe JASs are designed to be customized for the needs of each hospitalHospitals can use the HICS JASs as preparedHospitals can modify the HICS JASs based on:Hospital sizeAvailable resourcesResponse needsHospitals can craft their own, unique JAS
181JAS CustomizationHospitals are encouraged to use the HICS JAS model as a template for customized JASsMaintain the prescribed format and terminology to ensure the standardization benefit of NIMSModify the Operational Period Actions and Documents/Tools section appropriately for the facility and community
182JAS Customization Processes Review all HICS Job Action SheetsConvene subject matter experts and stakeholders from within institution to review job action sheetsEngage persons/staff who would fill those roles in an eventEnsure JASs meet hospital needsRevise content as necessary with details (e.g. correct telephone numbers, etc)Place own hospital logo on each JAS if desired
183JAS Training and Exercising JASs should be used in trainings and exercisingEnhance familiarity of position description, mission and actionsConduct focused drills with Branches and Sections to enhance understanding of the incident management team structure
184Section Summary The Job Action Sheets are: An incident management tool A series of actions to meet the incident responseAre divided in time phasesImmediate 0-2 hoursIntermediate – 2-12 hoursExtended – Greater than 12 hoursDemobilization/System RecoveryStandardized to facilitate interagency responseCustomizable for the unique facility needs/roles
187Incident Action Plans Incidents Action Plans: Provide all IMT personnel with direction for actions based on the objectives during the operational period**Are a means of communicating the overall incident objectives, including:Operational activitiesSupport activitiesA tool to successful transition of operational activities to HCC relief staffIncident action planning requires an understanding the hospital’s policy and directionIncident action planning is essential for a successful response and recoveryIAPlanning is not well done in hospitals. Please underscore the importance of Incident Action Planning and the planning process.
188Incident Action Plans IAP processes use Management by Objectives Setting the Operational PeriodDetermining overall prioritiesEstablishing specific, measurable, attainable objectivesSelecting effective strategies and tactics to accomplish objectivesIdentify needed resourcesDevelop and issue assignmentsDirect, monitor and evaluate response efforts to enhance response in the next op periodDocument resultsCorrective actions
189Incident Action Planning The IAP covers an Operational PeriodElements of an IAPWhat must be doneWho is responsibleHow information is communicatedWhat should be done if someone is injured
190Incident Action Planning Process The Incident Commander sets times for IAP meetingsThe Section Chiefs develop their Section’s action plan for the next operational periodInput from Branch and Unit staffSection IAP submitted to Planning ChiefAssimilated into a single HCC IAPDocumentation and Situation Unit Leaders compile the IAP
191Incident Action Planning Process Incident Action Planning Meeting conducted by the ICCommand Staff and General Staff attend the meetingIAP is discussed and modified, as neededNext Action Planning Meeting is determinedIC Approved and final IAP is distributed to HCC staffDistribution by the Documentation Unit Leader
192Incident Action Planning The IAP should be developed ASAP after the HCC is operationalIt becomes the preliminary guidance for a defined, short operational periodHICS forms to utilize:HICS Form 201 – Incident BriefingHICS Form 202 – Incident Objectives**HICS Form 203 – Organizational Assignment ListHICS Form 261 – Incident Action Plan Safety Analysis
193Section SummaryThe IAP provides all IMT personnel with direction for actions based on the objectives during the operational period**Incident Action Planning uses the elements of Management by ObjectivesIncident Action Planning is done by Command and General StaffIncident Action Planning is essential for effective response and recovery
196Incident Specific Planning During the initial response period, activities are guided by:Emergency Operations PlanIncident-specific guidesThese plans/guides assist the IC:To conduct a situation assessmentSet initial objectivesEstablish the HCC/ICS organization
197HICS IPGs and IRGsAn incident-specific scenario “sets the stage” for the IPGs and IRGs13 internal scenariosBased on most likely internal hospital incidents14 external scenariosBased on the Department of Homeland Security National Planning Scenarios
198Incident Planning and Response Guides Internal GuidesBomb ThreatEvacuationFireHazMat SpillHospital OverloadHostage/BarricadeInfant/child abductionInternal floodingLoss of HVACLoss of PowerLoss of WaterSevere weatherWork stoppageAll-Hazards GuideExternal GuidesNuclear DetonationBiological attack - AnthraxBiological disease outbreak -Pandemic InfluenzaBiological Attack – PlagueChemical Attack – Blister AgentChemical Attack – Toxic Industrial ChemicalsChemical Attack - Nerve agentChemical Attack – ChlorineNatural Disaster – EarthquakeNatural Disaster – HurricaneRadiological Attack – RDDExplosives Attack – IEDBiological Attack – Food ContaminationCyber AttackThere are only 14 external guides instead of the 15 in the National Planning Scenarios because number 14 is a veterinary problem of Foot and Mouth disease, that does not pose problem to hospital response and because the relative issues are addressed in the other external IPGs/IRGs
199Introductory Scenario Example: Internal Scenario - FireYour hospital is in the middle of the annual flu season. It is mid winter and it is unusually cold outside. The time is 10:30 PM. The hospital inpatient beds are at 95% capacity and there are patients holding in the ED to be admitted.A fire has broken out and has engulfed the laboratory area, and the fire sprinkler system in that area has activated. The fire department quickly responds and extinguishes the fire before it can spread beyond the laboratory area. The fire department assists with the smoke and water removal.Two staff members from the laboratory are injured with burns and smoke inhalation, one seriously and one in critical condition. The lab is totally destroyed and is unusable. The extensive smoke and water damage has spread to the ICU and the patient rooms above the lab. The staff are asking if they should evacuate the hospital. The local press is now on scene and is demanding information and access to the hospital.
200IPGs and IRGs Hospitals use these incident-specific guides According to the facility HVAThe community HVAAdditional IRGs and IPGs may need to be developed by the facility to address a hazard
202Incident Planning Guides Outline strategic planning considerations for incident-specific situationsFormatted to the emergency management phasesMitigation (including prevention)PreparednessResponseRecoveryUsed to evaluate the facility’s Emergency Operations PlanUsed to develop Incident Response Guides
203IPG: Example - FireDoes your Emergency Management Plan Address the following issues?Mitigation & PreparednessDoes the fire alarm and overhead announcement sound loudly enough to be heard in all locations?Does the fire alarm system include both audible and visual systems (e.g. alarm tone and flashing strobe lights)?Does the hospital have lighted emergency exits in all areas?Does the fire alarm automatically notify the local fire department?Does the hospital have a fire plan that includes closing and securing all doors and windows?Does the hospital have procedures to immediately shut off valves that control oxygen and other gases?
205Incident Response Guides Are incident-specificAre activated during responseProvide critical considerations and actions for the Command and General StaffAre time based:Immediate – 0-2 hoursIntermediate – 2-12 hoursExtended – Greater than 12 hoursDemobilization/System Recovery
206Incident Response Guides Should complementEmergency Operations PlanThey complement the EOP but not replace the EOPJob Action SheetsCan be used as initial documentation
207IRG – Example: Fire Directions Mission: To reduce the loss of life and property during an internal fire incident.Directions□Read this entire response guide and review incident management team chartUse this response guide as a checklist to ensure all tasks are addressed and completedObjectivesConfine the fire/reduce the spread of the fireRescue and protect patients and staffImplement internal emergency management plan – fire
208IRG – Example: Fire Immediate Actions (Operational Period 0-2 Hours) □COMMAND(Incident Commander):-- Activate the facility emergency operations plan and the Incident Command structure-- Appoint Command Staff and Section Chiefs-- Consider the formation of a unified command with hospital and fire officials-- Determine need for and type of evacuation(PIO):-- Establish a media staging area-- Conduct regular media briefings to update situation status and provide appropriate patient and employee information-- Oversee patient family notifications of incident and evacuation/relocation, if ordered
209IRGs and IPGs Uses of the Guides To evaluate the EOPA training toolTabletop exercisesAs a planning basis for a functional exerciseGuides will promote more immediate and higher quality decision-making
210JAS versus IRGs & IPGsThe IRGs are not intended to be a replacement for Job Action SheetsIRGsOverview position actions and decision makingAre Incident SpecificJASsDetail position actions, decisions and activitiesAre all-hazards focused
211Section Summary IPGs and IRGs Are incident-specific tools to assist hospitals with planning, training and response/recovery effortsAssist in meeting regulatory requirementsGuide Command and General Staff with decision-making and action-takingShould be consistent with the EOPDo not replace the JAS
214Using the HICS Forms Purpose: Use: To provide the incident management team with the documents needed to manage a responseUse:Each form has a specific purpose identified at the bottom of the formInstruction sheets for each form can be printed on reverse side of each form, if desiredForms have been modified from existing FEMA ICS forms for use in hospitals
215Value of Using HICS Forms Your facility will be consistent with other healthcare facilities and community respondersInformation can be more easily shared among all respondersDocumentation guides your response and assists in your recovery efforts
216Value of Using HICS Forms Serves as a road map in response: everyone acting from the same planServes as a foundation for corrective actionEnsures consistency and compliance with regulatory guidelinesComplies with NIMS Publications Management Standard*
217Using the HICS Forms Forms format includes: 20 HICS forms Form numberName of formWho is responsible for completionWhen form is to be completed20 HICS formsFound in the Guidebook Appendix DUtilize current facility forms + HICS forms for responseDevelop additional forms to meet the incidents
218Using HICS Forms Appropriate HICS forms completed by each HCC position Forms can be done electronically or hand-writtenWrite legibly and clearlyComplete all areas on the formCompleted forms distributed with a copy to the Planning SectionForms will be archived to document responseForms and other incident documentation used to craft the AAR
219HICS Forms No. Name Responsible 201 Incident Briefing Incident Commander202Incident ObjectivesSection Chiefs203Organizational Assignment ListResource Unit Leader204Branch Assignment ListBranch Directors205Communications LogCommunications Unit Leader206Staff Medical PlanSupport Branch Director207Organization Chart213Incident Message FormAll Positions214Operational LogCommand Staff and General Staff251Facility System Status ReportInfrastructure Branch DirectorThe light blue areas are the forms used in the Incident Action Planning Process
220No. Name Responsible 252 Section Personnel Time Sheet Section Chiefs 253Volunteer Staff RegistrationLabor Pool & Credentailiting Unit Leader254Disaster Victim / Pt Tracking FormPatient Tracking Manager255Master Pt Evacuation Tracking Form256Procurement Summary ReportProcurement Unit Leader257Resource Accounting Record258Hospital Resource DirectoryResource Unit Leader259Hospital Casualty / Fatality Report260Patient Evacuation Tracking FormInpt Unit Leader Outpt Unit Leader, Casualty Care Unit Leader261Incident Action Plan Safety AnalysisSafety Officer
221HICS 201 – Incident Briefing PurposeDocuments initial response information and actions taken at start-upOriginationIncident CommanderCopies toCommand staff, Section Chiefs, and Documentation Unit LeaderWhen to CompletePrior to briefing the current operational periodHelpful TipsDistribute to all staff before initial briefing
222HICS 201 – Incident Briefing InstructionsPrint legibly and enter complete informationIncident NameDate of briefingTime of BriefingEvent History and Current Actions TakenCurrent OrganizationNotes (warnings, directives, etc.)Prepared by (name and position)Facility Name
225Lab/West Wing Fire0800Fire broke out at 7:00 am in the main laboratory on the 2nd floor. Large amount of smoke with foul odor. Fire sprinklers activated.0705 HCC activated. EOP activated. Fire department enroute. Positions activated: Safety Officer, Operations Chief, Infrastructure Branch Director and Medical Care Branch Director0800 Fire department arrived and unified command established.Evacuation of patient care areas near the lab in progress. All depts instructed to send casualty reports to HCC.
227HICS 202 – Incident Objectives PurposeDefines objectives and issues for operational periodOriginationPlanning Section ChiefCopies toCommand staff, General Staff and Documentation Unit LeaderWhen to CompletePrior to briefing the current operational periodHelpful TipsServes as a roadmap to incident management
228HICS 202 – Incident Objectives InstructionsPrint legibly and enter complete informationIncident NameDate preparedTime preparedOperational Period Date and TimeGeneral Command and Control Objectives for the IncidentWeather / Environmental Implications for the PeriodGeneral Safety / Safety MessagesAttachmentsPrepared by (Planning Chief: use proper name)Approved by (Incident Commander)Facility Name
230Lab/West Wing Fire0800Ensure communications links to Fire Department, community hospitals and emergency operations center are functioningInitiate structural assessment of hospitalAssess injuries to patients, visitors and staff4. Establish alternate care sites as needed for patient evacuationsWinds from NE at 12 mph. Low fog remains, expected to dissipate by Temperatures currently 41 degrees; high of 55 expected with overnight temps to high 30’s. Rain forecast by weekend.
235HICS Form 213: Incident Message Form C Barton, OperationsR. O’Reilly, Logistics1000Call from the laboratory manager. States that the lab will not be functional due to major equipment damage from heat and smoke. Laboratory non-functional. Request transportation of stat lab specimens to the community laboratory for testing.
236HICS Form 213: Incident Message Form Community Laboratory called and will accept specimens and blood tubes for testing. Transporation van will pick up specimens and transport to the community lab at 1200.IMA Vampire1100
237HICS Form 214 Lab/West Wing Fire 2-27-07 2-27-07 0800-1500 Operations, Medical Care Branch0820Position Activated and situation briefing obtained0900West Unit patient care unit with major smoke damage. Patients with respiratory symptoms and anxiety. Ordered evacuation of the wingClara Barton
238HICS Form 254 Lab/West Wing Fire 2-27-07 2-27-07 0800-1500 1200 Transfer12302135Brad PittM34ED
245Section Summary The HICS forms: Provide the Incident Management Team with the documents needed to manage a responseAssist in communication with external agencies and resourcesAssist in communication with hospital staffProvide documentation for response and recovery activities
247External Agency Coordination Hospitals can no longer plan for emergencies in a siloEffective preparedness and response requires integration with other community respondersInclude local, regional and state respondersJoint Commission requires community-wide planning and collaboration with responders
248External Agency Coordination Hospitals should be actively engaged in community planning and preparednessPublic SafetyLaw enforcement/Medical Examiner or CoronerFireEMSPublic healthEmergency Management (local agency)Behavioral/Mental HealthOther public and private agencies
249Community Planning Meetings with response partners serve to: Increase understanding of response roles and limitationsDevelop regional response plans and proceduresPlan, conduct and evaluate collaborative exercisesConduct multi-disciplinary trainingBuild personal relationships across disciplines for better communication and response
250Hospital Collaboration Hospitals must also plan and prepare with other healthcare partnersWithin the corporate healthcare systemOther community hospitalsClinicsLong-term care facilitiesRegional Hospital Coordination CentersRegional Hospital AssociationsWithin the integrated healthcare system: hospitals that are part of a corporate or not-for-profit integrated healthcare system must also coordinate their planning and response activities with the administrative sections of their parent organization. System hospitals may develop emergency planning committees to ensure consistent planning and response and plan collaborative exercises. Healthcare systems may also activate a system operations center during an incident to coordinate inter system hospital needs and information sharing.
251Hospital Collaboration Hospitals in a community should meet regularlyCooperative planning and trainingConduct joint exercisesStandardization between hospitalsTerminologyUse of HICSMutual aid and scarce resource sharingIntegrated plans and proceduresHospitals should strive to standardize emergency management practices in communities.
252Hospital Collaboration Develop and sign mutual aid agreements or MOUsHow to request assistance from sister hospitalsSharing of resourcesHospital resourcesCommunity resourcesCredentialing of staff/volunteersInitiation of patient transfersStandardizing purchases of equipment and supplies (cost savings and increased capacity)
253Hospital Collaboration Achieving the hospital collaboration points will meet four NIMS elementsElement 1: Organizational adoption of NIMSElement 2: Utilization of ICSElement 3: Multi-agency coordination systemsElement 17: Standardized and consistent terminology
254Healthcare Provider Collaboration Hospital collaboration with non-hospital facilitiesClinicsUrgent Care Centers and MD officesLong-term care facilitiesInclude these providers in planning, training and exercisesThey can provide valuable resourcesCan augment healthcare capacity and preserve acute care hospitals for acute care
255Hospital Command Center Activation Once the HCC is activatedCommunication and information sharing with partners is vitalLiaison Officer is the formal line of communications into and out from the facilityBut some positions also have communication and coordination lines with community providers and responders….
257HICS and Unified Command Single agency command **One agency involved in the responseHospitals using HICS are single agency command structures
258HICS and Unified Command Unified command is instituted **When more than one responding agency is present or,The situation crosses political jurisdictionsLeaders from the agency are co-located for collaborative decision makingA unified IAP is developedUnified command may occur when hospitals are asked to respond to the incident scene
259HICS and Unified Command When does unified command apply to hospitals?When the hospital is the scene of the incident and other responders come to the facilityExample:Hostage situation – Law EnforcementHospital Fire – FireBomb threat –Bomb Squad/Law EnforcementBuilding collapse – Fire and Search & RescueWater outage/rupture – Public Works
260HICS and Unified Command Unified command in the HCCA Unified Incident Management Team (UIMT) would be formed in the HCCBomb Threat--- Hospital IC and Law Enforcement ICThe UIMT facilitatesInformation sharingIndividual agencies provide input into IAPEach agency retains individual authority over its assets and responsibilitiesAlthough there is equality, there still is a final authorityIn our example– who would that be?
261HICS and Area Command Area command is defined as: A command structure to oversee the management of large or multiple incidents with individual ICS structuresThe area command structureSets overall strategies and prioritiesAllocates critical resourcesEnsure incidents are properly managedEnsures overall objectives are achieved
262HICS and Area Command Hospital example: A large healthcare organization with multiple buildings on the facility groundsMain hospitalWomen’s hospitalMultiple clinicsA tornado occurs with scattered areas of activity and damage to multiple facilitiesAll buildings activate their incident command structures/HCCThe Main hospital serves as area command for all facilities, but each facility maintains an ICS structure
263Section SummaryHospitals must plan collaboratively with community responders for effective emergency response and recoveryEstablishing and rehearsing pre-event MOUs or mutual aid agreements will ensure effective responseHospitals may utilize unified command and area command structures in certain situations
266Rural and Small Hospital Challenges Preparedness apathy:“It can’t happen here!”Relative isolation:Geography/distance may isolate the facilityRemote distance from resources may delay assistanceLimited resources and surge capacity:Fewer resources in the hospital and communityLocal government resources limitedLimited reliable and redundant communications
267Small and Rural Hospital Challenges Limited healthcare personnel resourcesOverlapping community rolesHealthcare providers serving on EMS unitsReliance on community volunteersLimited fundingGovernment grants based on populationPopulation bases do not account for “seasonal” surge (i.e., vacation time, concerts, large events)
268Small and Rural Hospital Challenges Rural areas may be the destination for urban residents during an incident!Large numbers will quickly overwhelm resourcesNational guidelines and recommendationsMostly focus on urban and suburban regionsDo not account for variances in rural communitiesYet, rural and small hospitals must meet all standards or recommendations!
269Smaller and Rural Hospitals! Using HICS inSmaller and Rural Hospitals!It Can Be Done!
270The complete IMT is depicted The complete IMT is depicted. How do we take 78 potential positions and scale it for small and rural facilities?
271HICS for Smaller Facilities Adapt HICS to your facilityConsolidate positionsMaintain the basic command structureThe Medical/Technical Specialist role does not have to be maintained, but the basic command structure should be!
272HICS for Smaller Facilities Adapt HICS to your facilityCombine the duties of like positions under the BranchesCondense the JAS with critical duties for like positions listedConcentrate on the main Sections and Branches or critical Unit Leaders
274HICS For Smaller Facilities When adapting the IMT and consolidating positions,Create JASs for each positionInclude critical actionsIn mission statementIn JAS elementsSuggest having the full IMT JAS availableIf a large incident and help arrivesEach position can then be activated
275Section SummaryThe HICS IMT can be adapted for smaller and rural facilitiesJASs can be created for consolidated positionsMaintaining mission statements and titleRemember, you only activate positions as needed to meet the incidentKeep all HICS JAS in the event positions need to be expanded
277Summary of the Day Today we have learned about: NIMS and ICS concepts and principlesNIMS Implementation Activities for HospitalsThe origins of HICSThe Hospital Incident Command SystemIncident Management TeamCommand and General StaffAll HICS positions
278Summary of the Day Today we learned about: The importance of Incident Action PlanningHICS MaterialsJob Action SheetsIncident Planning and Response GuidesFormsRelationship of the Hospital to Community RespondersHICS for Rural and Small Hospitals
279Evaluation of the DayHow was the courseso far????