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National Incident Management System (NIMS)

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1 National Incident Management System (NIMS)
National Response Framework (NRF) Hospital Incident Command System (HICS) IS 100.HC, 200.a, 700.a, 800.b The University of South Alabama Center for Strategic Health Innovation © University of South Alabama Center For Strategic Health Innovation. All Rights Reserved. These slides are a part of the ARRTC program and cannot be reproduced for commercial purposes.

2 NIMS National Incident Management System
A standardized, all-hazard incident and resource management concept. A comprehensive, national approach to incident management that is applicable to all jurisdictional levels and across functional disciplines. ( ) The intent is to be applicable across a full spectrum of potential incidents and hazard scenarios, regardless of size or complexity ( ) Designed to improve coordination and cooperation between public and private entities in domestic management activities. Response actions will be based on the ICS system. All First Responders comply with NIMS training requirements.

3 NIMS National Incident Management System
Established to create uniformity: Organization Structure (ICS) Plans Training/Exercises Organization Resources Communications/Technology

4 NIMS Implementation Activities for Hospitals
Similar to expectations placed on government agencies Consists of 14 objectives for FY 2009 We will cover all requirements in detail in the next section: “Update on NIMS Requirements”.

5 NIMS Compliance HSPD-5 issued in 2004
For disaster response agencies and departments, NIMS made a condition for Federal assistance Confusion over initial NIMS compliance for hospitals and healthcare facilities Initial compliance date Oct 1, 2006 pushed back to Oct 1, 2007. Annual FY requirements and 5-year plan ( )

6 National Response Framework
Went into effect in March 2008. Updated and revised the National Response Plan. The NRF establishes . . . Federal coordination structures/mechanisms Direction for incorporation of existing plans Consistent approach to managing incidents Coordination ( )

7 Relationship: NIMS vs. NRF
Aligns command, control, organization structure, terminology, communication protocols, & resources/resource-typing Used for all events Resources Knowledge Federal NRF Integrates & applies Federal resources, knowledge, & abilities before, during, & after an incident Implemented for incidents requiring Federal coordination Abilities Response or Support State Response or Support Local Response Incident ( )

8 NRF Applicability The NRF applies to all Federal departments and agencies that have primary jurisdiction for or participate in operations requiring a Federal response, including: Major disasters, emergencies, and terrorist incidents including threats Other events of lesser severity requiring a coordinated Federal response

9 Incidents of National Significance
The NRF distinguishes between: Incidents that require the Secretary of Homeland Security to manage the Federal response, termed Incidents of National Significance, and, The majority of incidents occurring each year that are handled by responsible jurisdictions or agencies DHS Secretary must declare an event as an Incident of National Significance

10 NRF Structure Base Framework Describes the domestic incident management structures and processes Appendixes Include acronyms, definitions, authorities, and a compendium of national interagency plans Emergency Support Function Annexes Describe the structures and responsibilities for coordinating incident resource support Support Annexes Provide guidance for the functional processes and administrative requirements Incident Annexes Address contingency or hazard situations requiring specialized application of the NRF

11 Scope of Emergency Support Functions
ESF #1 – Transportation Department of Transportation Aviation/airspace management and control Transportation safety Restoration/recovery of transportation infrastructure Movement restrictions Damage and impact assessment ESF #2 – Communications Homeland Security/NCS Coordination with telecommunications and information technology industries Restoration and repair of telecommunications infrastructure Protection, restoration, and sustainment of national cyber and information technology resources Oversight of communications within the Federal incident management and response structures ESF #3 – Public Works and Engineering Department of Defense US Army Corps of Engineers Infrastructure protection and emergency repair Infrastructure restoration Engineering services and construction management Emergency contracting support for life-saving and life-sustaining services ESF #4 – Firefighting Department of Agriculture Coordination of Federal firefighting activities Support to wildland, rural, and urban firefighting operations

12 Scope of Emergency Support Functions
ESF #5 – Emergency Management Homeland Security/FEMA Coordination of incident management and response efforts Issuance of mission assignments Resource and human capital Incident action planning Financial management ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services Homeland Security/FEMA Mass care Emergency assistance Disaster housing Human services ESF #7 – Logistics Management and Resource Support Homeland Security/FEMA Comprehensive, national incident logistics planning, management, and sustainment capability Resource support (facility space, office equipment and supplies, contracting services, etc.) ESF #8 – Public Health and Medical Services Dept Health & Human Srvcs. Public health Medical Mental health services Mass fatality management

13 Scope of Emergency Support Functions
ESF #9 – Search and Rescue Homeland Security/FEMA Life-saving assistance Search and rescue operations ESF #10 – Oil and Hazardous Materials Response EPA Oil and hazardous materials (chemical, biological, radiological, etc.) response Environmental short- and long-term cleanup ESF #11 – Agriculture and Natural Resources Department of Agriculture Nutrition assistance Animal and plant disease and pest response Food safety and security Natural and cultural resources and historic properties protection and restoration Safety and well-being of household pets ESF #12 – Energy Department of Energy Energy infrastructure assessment, repair, and restoration Energy industry utilities coordination Energy forecast

14 Scope of Emergency Support Functions
ESF #13 – Public Safety and Security Department of Justice Facility and resource security Security planning and technical resource assistance Public safety and security support Support to access, traffic, and crowd control ESF #14 – Long-Term Community Recovery Homeland Security/FEMA Social and economic community impact assessment Long-term community recovery assistance to States, local governments, and the private sector Analysis and review of mitigation program implementation ESF #15 – External Affairs Homeland Security/FEMA Emergency public information and protective action guidance Media and community relations Congressional and international affairs Tribal and insular affairs

15 Incident Command System
ICS Incident Command System

16 HICS is: A Proven Emergency Management System Based on Military and Fire Management Chains of Command Designed for all hazards and all sizes of response, as necessary Flexible and adaptable – only activate what is needed. Manages routine or planned events Provides logistical & administrative support to operational personnel Improves Communication – Formal and Informal Cost effective – avoids duplication of effort Allows for adaptation into a common response structure ( ; ; /7)

17 Characteristics of ICS
Common Terminology ( /9) Modular organization Reliance on an Incident Action Plan (IAP) Management by objectives Chain of command and Unity of command ( ) Unified Command ( ) Manageable Span of Control ( /21; ) Emergency Operations Centers Resource Management Information, Intelligence and Communications

18 ICS Terminology Sections Divisions Groups Branches Task Forces
Strike Teams Resources

19 Sections Organizational levels with responsibility for a major functional area of the incident Operations Planning Logistics Finance/Administration The person in charge is the Chief

20 Divisions and Groups Divisions Divide an incident geographically
Is led by a Supervisor Groups Established based on the needs of an incident. Labeled according to the job that they are assigned Managed by a Supervisor Work wherever their assigned task is needed and are not limited geographically

21 Branches and Units Branches
Established if the number of Divisions or Groups exceeds the span of control Have functional or geographical responsibility for major parts of incident operations Managed by a Branch Director ( ) Units Organizational elements that have functional responsibility for a specific activity

22 Task Forces Task Forces are a combination of mixed resources with common communications Operate under the direct supervision of a Task Force Leader

23 Strike Teams Strike Teams are a set number of resources
Of the same kind and type With common communications Operate under the direct supervision of a Strike Team Leader

24 Resources Single: An individual(s) or piece of equipment with its personnel complement; or, A crew or team of individuals with an identified supervisor Staging Areas hold resources waiting for operational assignment ( ; ) Typing: Identifies size, capability and staffing qualifications ( ) Assigned, Available or Out-of-Service ( )

25 ICS Supervisory Titles
Organizational Level Title Support Position Incident Command Commander Deputy (* Able to assume command!) Command Staff Officer Assistant General Staff (Section) Chief Branch Director Division/Group Supervisor N/A Unit Leader Manager Strike Team/Task Force Single Resource Boss Distinct titles = most qualified 2. Standard titles = easy requests 3. Titles = common standard ( ; ; )

26 Other Command Issues & Terms
Initiation of Command Transfer of Command Termination of Command Demobilization ( , pg 121) - Facilitates accountability Credentialing ( , pg 129) - Competence and proficiency Area Command, On-Scene Command ( , pg 155) - multiple incidents handled by separate IC orgs.

27 Specific Command Issues
Initiation of Command: IC or Temporary IC need to know what they do Must be able to recognize the need to activate HICS Need a list of criteria to make the decision Have a group or select staff to ask for advice Update EOP with “Activation” section Need to understand “Transfer of Command”

28 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 authority. ( ) All with a need to know should be told the effective time and date of the transfer ( )

29 Specific Command Issues
Termination of Command: IC needs to know what they do Must be able to recognize the time to de-activate HICS Need a list of criteria to make the decision Have a group or select staff to ask for advice Update EOP with “Activation” section Need to understand demobilization and what is involved

30 Specific Command Issues
Demobilization: The process of standing down Getting back to a normal schedule and routine Replacing equipment and supplies Adjusting personnel back to routine Planning begins at the same time as mobilization Facilitates accountability and efficiency Occurs in the Planning Section ( )

31 Specific Command Issues
Credentialing: Evaluation and documentation of an individual's: Current certification, license, or degree Training and experience Competence or proficiency Critical for health care agencies National, state, local AND agency requirements Legal implications ( )

32 Specific Command Issues
Area Command: Creates to oversee the management of: Multiple incidents that are each being handled by an Incident Command System organization A very large incident that has multiple Incident Management Teams assigned to it Designed to ensure the effective management of assigned incidents ( )

33 Management by Objectives Tactical Results, Needs,
Incident Occurs Incident Reported & Identified Tactical Response ICS Launched Chiefs Meeting: Develop Strategy & Tactics to Meet Objectives IC Sets Objectives Incident Action Plan ( ) ( /18) ( ) Chiefs & Officers Set Meeting with IC to Re-evaluate Tactical Response Initiated Operation Reports Tactical Results, Needs, Engage Liaison, Logistics, Planning, Finance for support Planning Evaluates Progress Reports

34 ICS Form 201 – Incident Briefing Form
An eight-part form that provides an Incident Command/Unified Command with basic information that can be used to brief incoming resources, an incoming Incident Commander or team, or an immediate supervisor. The basic information includes the: Incident situation (map and significant events). Incident objectives. Summary of current actions. Status of resources assigned to or ordered for the incident or event. Can serve as the initial Incident Action Plan (IAP) for the first shift change and will remain in force and continue to develop until the response ends, or until a Planning Section has been established and generates, at the direction of the Incident Commander, an IAP. Suitable for briefing assigned and newly arriving Command and General Staff members. ( )

35 ICS Form 201 Page 1 of 8 pages See handouts

36 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, an HICS chart that matches (or comes close to matching) your day-to-day organizational chart is much more effective and understood during an event.

37 Incident Command System (ICS) Model
Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer ( ) Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff ( ; ; )

38 HOSPITAL INCIDENT COMMAND SYSTEM
HICS (2003)

39 HOSPITAL INCIDENT COMMAND SYSTEM
HICS (2006)

40 The Five Sections Command = the buck stops here
Planning = creates & develops incident plan Operations = implement the plan. Logistics = supports the plan. Finance = pays for the plan.

41 ICS – Command Section Incident Commander Public Information Officer
Liaison Officer Command Staff Safety & Security Officer Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff

42 Incident Commander Manages all emergency activities, including development, implementation, and review of strategic decisions from the Command Post, as well as post event assessment during recovery. Top priority = Safety! ( ; ; ; ) Serves as the authority for all emergency response efforts and supervisor to the Public Information Officer (PIO), Liaison Officer, Safety Officer, Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance & Administration Section Chief. 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. ( )

43 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. Be the organizer of correct information. Manage the facility’s Public Information Plan.

44 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. ( )

45 Liaison Officer Is responsible for coordinating with external partners, such as the city, 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 ( ; /12)

46 Legal Officer Provides legal and ethical advice to the IC, Command Staff, General Staff and the agency. Brought about by recent issues in hospitals in New Orleans post Katrina.

47 Incident Command System (ICS) Model
Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff

48 Logistics Section “Boy, do I need stuff”

49 Logistics Chief Food Shelter Supplies Comms Equipment Transportation
Organize and direct operations associated with the maintenance of the physical environment: Food Shelter Supplies Comms Equipment Transportation Medical support ( ; )

50 Logistics Chief Facility Unit Leader Communications Unit Leader
Transport Unit Leader Materials Supply Unit Leader Nutritional Supply Unit Leader

51 Incident Command System (ICS) Model
Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff

52 Planning

53 Planning Chief Organize and direct all aspects of the planning section - Incident Action Plan Usually runs the Operational Period briefing (Team Chief strategy meeting) Document and distribute the facility action plan. Ensure distribution of critical information/data. Compile scenario projections from all section chiefs and effect long range planning. Ensure adequate personnel for response. ( /24; )

54 Planning Chief Situation Status Unit Leader Labor Pool Unit Leader
Medical Staff Unit Leader Patient Tracking Officer Patient Information Officer

55 Incident Command System (ICS) Model
Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff

56 Finance Section $$ $$ MONEY MONEY MONEY MONEY

57 Finance Section Monitor the utilization of financial assets.
Oversee the acquisition of supplies and services to carry out the medical mission. Supervise the documentation of expenditures relevant to the emergency incident. Pre-planning for a rainy day Business RECOVERY ( /47; )

58 Finance Chief Time Unit Leader Procurement Unit Leader
Claims Unit Leader Cost Unit Leader

59 Incident Command System (ICS) Model
Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff

60 Operations Section Day to Day activities – On Steroids!
Provision of Care – “Your Hospital’s Mission” Known as the Tactical Response: Operations, Objectives and Direction. ( /5) ( ) ( )

61 Operations Chief Medical Staff Director Medical Care Director
Ancillary Services Director Human Services Director

62 Operations Chief Medical Staff Director Medical Care Director
In-Patient Areas Supervisor Treatment Areas Supervisor Surgical Services Unit Leader Triage Unit Leader Discharge Unit Leader Maternal & Child Unit Leader Immediate Tx Unit Leader Morgue Unit Leader Critical Care Unit Leader Delayed Tx Unit Leader General Nursing Unit Leader Minor Tx Unit Leader Out-Patient Services Leader

63 Psychological Support
Operations Chief Human Services Director Staff Support Unit Leader Psychological Support Unit Leader Dependent Care Unit Leader

64 Operations Chief Ancillary Services Director Laboratory Unit Leader
Pharmacy Unit Leader Radiology Unit Leader Cardiopulmonary Unit Leader

65 Job Action Sheets Each role’s assignments Checklists
Prioritizes duties No duplication of duties Responsibilities outlined Important that staff know to read their Job Action Sheet at the START!!!

66 Public Health ICS System (PHICS)

67 PHICS Incident Commander Public Information Officer
Liaison Officer - External Liaison Officer -Internal Safety and Security Officer Legal Officer Logistics Chief Planning Chief Finance Chief Operations Chief

68 ADPH Incident Command System Positions Chart
Incident Management Advisory Group/ CEP Incident Commander Public Information Officer Safety and Security Officer Liaison Officer Internal Legal Officer Liaison Officer External Logistics Chief Planning Chief Finance Chief Operations Chief Communications Unit Leader Situation Status Unit Leader Time Unit Leader Operations Section continued on next page Damage Assessment Unit Leader Human Resources Unit Leader Procurement Unit Leader Strategic Epidemiology & Surveillance Unit Leader Transportation Unit Leader Materials Supply & Nutrition Unit Leader ADPH Incident Command System Positions Chart January 4, 2010

69 ADPH Incident Command System Positions Chart - Operations
Incident Commander Incident Management Advisory Group/ CEP Public Information Officer Safety and Security Officer Liaison Officer Internal Legal Officer Liaison Officer External Operations Chief Laboratory Branch Environmental Group Medical Care Branch Subject Matter Experts Biological Chemical Radiation Zoonotic Infection Control Field Surveillance Branch Food Safety Group Medical Needs Shelter Pharmaceutical Support Pharmacy Social Service Coordination Branch Laboratory Branch Pharmaceutical Support Vaccination ADPH Incident Command System Positions Chart - Operations January 4, 2010 EMS Group Patient Management Group Patient Placement Unit

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79 Questions


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