2 NIMS - National Incident Management System A standardized, all-hazard incident and resource management conceptA national approach to incident management that is applicable to all jurisdictional levelsApplicable across a full spectrum of incidents and scenarios, regardless of sizeImprove coordination and cooperation between public and private entitiesResponse actions will be based on the ICS systemAll Response Agencies must comply with NIMS
3 NIMS: NIMS Implementation Objectives: Preparedness - Planning, Training and ExercisesCommunication and Information ManagementCommand and ManagementNIMS Adoption
4 NIMS - National Incident Management System Established to create uniformity:Organization Structure (ICS)PlansTraining/ExercisesResourcesCommunications/TechnologyOrganization
5 NIMS Implementation Requirements Activities for Health Care Agencies July 1, 2012 Consists of 11 Elements
6 NIMS ComplianceHSPD-5 (Management of Domestic Incidents) issued in 2004For disaster response agencies and departments, NIMS is a condition for Federal Preparedness assistanceNIMS Implementation for Healthcare Organizations GuidanceRevised activities from 14 to 11DHHS requires that healthcare organizations implement NIMS in order to eligible for preparedness funding through ASPR/HPP program.
7 Organizational Implementation Requirements Adoption:Element 1 - Adoption of NIMS…throughout the healthcare organization including all appropriate departments and business units.NIMS objectives addressed in the facility’s Emergency Management Program (EMP/Emergency Operations Plan – EOP) documentation.Include a statement of adoption of NIMS in the EOPRefer to this tool and attach as an annex or sub-section of the EOPObtain leadership support and have them review/sign plansAssign a NIMS Compliance Officer
8 Organizational Implementation Requirements Adoption:Element 2 – Federal Preparedness awards support NIMS Implementation…in accordance with the eligibility and allowable use of the awards.Utilize the Hospital Preparedness Program (HPP) funding for NIMS training courses.Document that HPP funds purchase standardized equipment in the county/state/ country.The EMP documentation includes the use of ICS and associated activities.
9 Organizational Implementation Requirements Preparedness: PlanningElement 3 – Revise and Update EOPs, SOPs and SOGs to incorporate NIMS components.Revise plans as necessary to incorporate:PlanningTrainingResponseExercisesEquipmentEvaluationCorrective Action
10 Organizational Implementation Requirements Preparedness: PlanningElement 4 - Mutual-Aid and/or Assistant Agreements…to include public/private sector and non-governmental organizations.The EMP references Memorandums of Understanding (MOUs), agreements and/or mutual aid developed with hospitals, other healthcare providers, local public health, Emergency Medical Services (EMS), fire and safety, pharmacies, medical suppliers, water/food/fuel suppliers, etc.
11 Organizational Implementation Requirements Preparedness: Training and ExercisesElement 5 – IS 100, 200 and 700.Personnel to fill ICS Positions who must have documented training:PhysiciansNursesAncillaryMaterials/ResourceManagersSecurity/SafetyLaboratoryRadiologyInter-facility TransportMaintain a record of completion and copies of completion certificates
12 Organizational Implementation Requirements Preparedness: Training and ExercisesElement 6 – IS 800Those who take the lead in key ICS positionsKey staff members – Liaison, Safety/Security, Legal…Incident CommanderEmergency Management PlannerMaintain a record of completion.Copies of completion certificates should also be maintained.
13 Organizational Implementation Requirements Preparedness: Training and ExercisesElement 7 – Apply NIMS/ICS to training and exercisesUtilize HICS for disaster exercises and actual eventsThe EMP training and exercise documentation reflects the use of NIMS and HICSUtilize Homeland Security Exercise and Evaluation (HSEEP)Work in partnership with local/regional healthcare providers within the community to organize training and exercises that use NIMS and HICSHospital should develop goals and objectives to follow during a drill that tests their ability to activate HICS, open their Command Post, develop and implement an Incident Action Plan (IAP), and communicate with partnersDevelop/use After Action Reports and Corrective Action Plans
14 Organizational Implementation Requirements Communication and Information Management:Element 8 – Processes, Equipment, Communication and Data interoperabilityFacilitate collection and distribution of consistent & accurate informationSituational awareness of logistical resourcesEquipment purchased through the HPP is standardizedThe EMP documentation includes emphasis on the interoperability of response equipment and communications and data systems with external agenciesSystems such as AIMS, ALERT, Web-EOC, etc. show compliance if utilized among healthcare facilities, county/area or state-wide.
15 Organizational Implementation Requirements Communication and Information Management:Element 9 – Common and consistent terminologyThe EMP includes emphasis on the use of plain English by staff during emergencies. Review and update EOP annually.Document a statement to this effect in the EMP documentation or EOP.Utilize a HICS acronym list.
16 Organizational Implementation Requirements Command and Management:Element 10 – Manage events with ICSThe EOP explains the use of HICS, particularly incident action planning, a common communications plan and five specific activities: Initiation of Command, Transfer of Command, Termination of Command, Demobilization and Credentialing.Documentation utilization of HICS or other approved ICS structures as detailed in #7.
17 Command Issues & Terms Initiation of Command Transfer of Command Termination of CommandDemobilization - Facilitates accountabilityCredentialing - Competence and proficiency
18 Specific Command Issues Initiation of Command:IC or Temporary IC need to know what they doMust be able to recognize the need to activate HICSNeed a list of criteria to make the decisionHave a group or select staff to ask for adviceUpdate EOP with “Activation” sectionUnderstand how to transition into “Transfer of Command”
19 Specific Command Issues Transfer of Command:Follow EOP guidelines after “Initiation of Command”Upon arrival, the higher ranking individual will assume command, maintain command or reassign to a third party.Delegation of authority can occur if the scope of the response is complex or beyond capabilities or current/initial Incident CommanderAll with a need to know should be told the effective time and date of the transfer.
20 Specific Command Issues Termination of Command:IC needs to know what they doMust be able to recognize the time to de-activate HICSNeed a list of criteria to make the decisionHave a group or select staff to ask for adviceUpdate EOP with “De-Activation” sectionUnderstand the transition into demobilization
21 Specific Command Issues Demobilization: The process of standing downGetting back to a normal schedule and routineReplacing equipment and suppliesAdjusting personnel back to routinePlanning begins at the same time as mobilizationFacilitates accountability and efficiencyOccurs in the Planning Section
22 Specific Command Issues Credentialing: Evaluation/documentation of an individual's:Current certification, license, or degreeTraining and experienceCompetence or proficiencyCritical for health care agenciesNational, state, local AND agency requirementsLegal implications
23 Organizational Implementation Requirements Command and Management:Element 11 – Adopt Public Information (PI) principles by using both JIS and JIC during events (Examples)The EOP explains the management and coordination of public information with external entitiesIndentify a PIO who is responsible for medial and public information as it pertains to an event. The PIO should establish working relationships, prior to an event with local media, EMA, law enforcement, public health, EMS, and other responding agenciesPIO understands the relationship with the Joint Information System and Joint Information CenterDocumentation that the hospital participates in the JI process locally
24 Questions and/or a copy of the NIMS compliance manual:
25 National Response Framework Went into effect in March 2008.Updated and revised the National Response Plan.The NRF establishes . . .Federal coordination structures/mechanismsDirection for incorporation of existing plansConsistent approach to managing incidentsCoordination
26 Relationship: NIMS vs. NRF NIMS Aligns command, control, organization structure, terminology, communication protocols, & resources/resource-typingUsed for all eventsNRFIntegrates & applies Federal resources, knowledge, & abilities before, during, & after an incidentImplemented for incidents requiring Federal coordinationFederalResponse or SupportStateResponse or SupportLocalResponseIncident
27 NRF Structure Base Framework Describes the domestic incident management structures and processesAppendixesInclude acronyms, definitions, authorities, and a compendium of national interagency plansDescribes the structures and responsibilitiesfor coordinating incident resource supportEmergency Support Function AnnexesSupport AnnexesProvide guidance for the functional processes and administrative requirementsIncident AnnexesAddress contingency or hazard situations requiring specialized application of the NRF
28 Scopes of ESFs ESF #1 – Transportation Department of Transportation Aviation/airspace management and controlTransportation safetyRestoration/recovery of transportation infrastructureMovement restrictionsDamage and impact assessmentESF #2 – CommunicationsHomeland Security/NCSCoordination with telecommunications and information technology industriesRestoration and repair of telecommunications infrastructureProtection, restoration, and sustainment of national cyber and information technology resourcesOversight of communications within the Federal incident management and response structuresESF #3 – Public Works and EngineeringDepartment of DefenseUS Army Corps of EngineersInfrastructure protection and emergency repairInfrastructure restorationEngineering services and construction managementEmergency contracting support for life-saving and life-sustaining servicesESF #4 – FirefightingDepartment of AgricultureCoordination of Federal firefighting activitiesSupport to wild land, rural, and urban firefighting operations
29 Scopes of ESFs ESF #5 – Emergency Management Homeland Security/FEMACoordination of incident management and response effortsIssuance of mission assignmentsResource and human capitalIncident action planningFinancial managementESF #6 – Mass Care, Emergency Assistance,Housing, and Human ServicesHomeland Security/FEMAMass careEmergency assistanceDisaster housingHuman servicesESF #7 – Logistics Management and Resource SupportHomeland Security/FEMAComprehensive, national incident logistics planning, management, and sustainment capabilityResource support (facility space, office equipment and supplies, contracting services, etc.)ESF #8 – Public Health and Medical ServicesDept Health & Human ServicesPublic healthMedicalMental health servicesMass fatality management
32 TierFederal ResponseDHHSTierInter-state CoordinationRegion 4 DHHSTierIntra-state CoordinationADPH/CEPArea Jurisdiction Response:Area Health Care CoalitionTier 3---Area PHCounty Jurisdiction Response:County Health Care CoalitionTier 2 ---County PHTier 1----Health Care Facility ResponseHCF
33 Scopes of ESFs ESF #9 – Search and Rescue Life-saving assistance Homeland Security/FEMALife-saving assistanceSearch and rescue operationsESF #10 – Oil and Hazardous Materials ResponseEPAOil and hazardous materials (chemical, biological, radiological, etc.) responseEnvironmental short- and long-term cleanupNutrition assistanceAnimal and plant disease and pest responseFood safety and securityNatural and cultural resources and historic properties protection and restorationSafety and well-being of household petsESF #11 – Agriculture and Natural ResourcesDepartment of AgricultureESF #12 – EnergyDepartment of EnergyEnergy infrastructure assessment, repair, and restorationEnergy industry utilities coordinationEnergy forecast
34 Scopes of ESFs ESF #15 – External Affairs Homeland Security/FEMA ESF #13 – Public Safety and SecurityDepartment of JusticeFacility and resource securitySecurity planning and technical resource assistancePublic safety and security supportSupport to access, traffic, and crowd controlESF #14 – Long-Term Community RecoveryHomeland Security/FEMASocial and economic community impact assessmentLong-term community recovery assistance to States, local governments, and the private sectorAnalysis and review of mitigation program implementationESF #15 – External AffairsHomeland Security/FEMAEmergency public information and protective action guidanceMedia and community relationsCongressional and international affairsTribal and insular affairs
35 Incident Command System ICSIncident Command System
36 Incident Command System (ICS) Model Incident CommanderPublic InformationOfficerLiaisonOfficerCommandStaffSafety & SecurityOfficerLogistics SectionChiefPlanning SectionChiefFinance/AdminSection ChiefOperations SectionChiefGeneralStaff
37 Incident Command System Organizational Charts Theoretically, your ICS chart should not correlate with any administrative organizational chart in you facility:Creates confusion over position titles and duties.In reality, for hospitals, a HICS chart that matches (or comes close to matching) your day-to-day organizational chart is much more effective and understood during an event.
43 ICS – Command Section Incident Commander Public Information Officer LiaisonOfficerCommandStaffSafety & SecurityOfficerLogistics SectionChiefPlanning SectionChiefFinance/AdminSection ChiefOperations SectionChiefGeneralStaff
44 Incident CommanderManages all emergency activities, usually from the Command Post.Top priority = Safety!Serves as the authority for the response efforts and is supervisor to the Command and General Staff.May serve as any or all of the positions in the Command and General Staff, depending on the complexity of the event.Is IC until authority is transferred to another person.The only position ALWAYS staffed in an ICS activation.
45 Public Information Officer Responsible for relaying incident related information to the public, other organizations and the media.Participate in a Joint Information System (JIS) and work in the local Joint Information Center (JIC) when activated.Communicates with other agencies’ public information officers.The organizer of correct information.Manage the facility’s Public Information Plan.
46 Safety & Security Officer Monitors, evaluates and recommends procedures for all incident operations for hazards and unsafe conditions.Monitors, evaluates and recommends procedures for all incident operations, including the health and safety of emergency responder personnel.Organizes and reinforces scene/facility protection and traffic.Establish a security command post.
47 Liaison OfficerIs responsible for coordinating with external partners, such as the county, state, federal agencies, and public and private resource groups, as well as other Health Care Facilities.Serves as the incident contact person for representatives from other agencies and may work from the local Emergency Operations Center.Communicates into and out of the hospital.Works closely with the IC and PIO
48 Legal OfficerProvides legal and ethical advice to the IC, Command Staff, General Staff and the agency.
49 Incident Command System (ICS) Model Incident CommanderPublic InformationOfficerLiaisonOfficerCommandStaffSafety & SecurityOfficerLogistics SectionChiefPlanning SectionChiefFinance/AdminSection ChiefOperations SectionChiefGeneralStaff
51 Logistics Chief Facility Unit Leader Communications Unit Leader 2003Facility Unit LeaderCommunications Unit LeaderTransport Unit LeaderMaterials Supply Unit LeaderNutritional Supply Unit Leader
52 Logistics Chief Service Branch Director Support Branch Director 2006 Communications UnitITAS UnitStaff Food and Water UnitSupport Branch DirectorEmployee Health and Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool and Credentialing Unit
53 Incident Command System (ICS) Model Incident CommanderPublic InformationOfficerLiaisonOfficerCommandStaffSafety & SecurityOfficerLogistics SectionChiefPlanning SectionChiefFinance/AdminSection ChiefOperations SectionChiefGeneralStaff
55 Planning Chief Situation Status Unit Leader Labor Pool Unit Leader 2003Situation Status Unit LeaderLabor Pool Unit LeaderMedical Staff Unit LeaderPatient Tracking OfficerPatient Information Officer
56 Planning Chief 2006 Resource Unit Leader Situation Unit Leader Personnel TrackingMaterial TrackingSituation Unit LeaderPersonnel TrackingMaterial TrackingDocumentation Unit LeaderDemobilization Unit Leader
57 Incident Command System (ICS) Model Incident CommanderPublic InformationOfficerLiaisonOfficerCommandStaffSafety & SecurityOfficerLogistics SectionChiefPlanning SectionChiefFinance/AdminSection ChiefOperations SectionChiefGeneralStaff
66 Operations Chief 2006 Staging Manager Medical Care Branch Director Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging TeamMedical Care Branch DirectorInpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit