1. Healthcare Facilities Incident Command ( Principles ) Tehran University of Medical Sciences School of Public Health Department of Disaster Public Health Ministry of Health & Medical Education National Institute of Health Research Department of Disaster & Emergency Health Shahid Sadoughi University of Medical Sciences Allied Medical School PreHospital Emergency Care Department

2. Introduction During a Disaster Preparedness and Organization of a healthcare facility Required to Maximize the utilization of the available resources To Provide The highest achievable level of care for the community During a Disaster Preparedness and Organization of a healthcare facility Required to Maximize the utilization of the available resources To Provide The highest achievable level of care for the community

3. The highest achievable level of care for the community require to: Development of an Emergency Management Program (EMP) aimed at: 1) Protecting the facility and its people (patients and staff) 2)Responding to the community’s increased healthcare needs 3)Continuing to provide healthcare services 4)Assuring the safety of all involved Development of an Emergency Management Program (EMP) aimed at: 1) Protecting the facility and its people (patients and staff) 2)Responding to the community’s increased healthcare needs 3)Continuing to provide healthcare services 4)Assuring the safety of all involved

4. HealthCare's Facility Management (Normal Condition Vs. Disaster) Normal Condition: Functioning and managing healthcare utilizing consensus decision-making based on extensive data Disaster: Requires that time-sensitive decisions be made with imperfect information Normal Condition: Functioning and managing healthcare utilizing consensus decision-making based on extensive data Disaster: Requires that time-sensitive decisions be made with imperfect information

5. Command Structure Controlling the situation not only requires planning, it requires the delineation of alternate roles and responsibilities of hospital staff in an organized management system Central to this organization is a command structure that details the roles and responsibilities of those involved in leading the healthcare facility through all phases of a disaster Controlling the situation not only requires planning, it requires the delineation of alternate roles and responsibilities of hospital staff in an organized management system Central to this organization is a command structure that details the roles and responsibilities of those involved in leading the healthcare facility through all phases of a disaster

6. Focus of ICS Incident management focuses on  Command Control Coordination  Through a responsibility-oriented chain of command Incident management focuses on  Command Control Coordination  Through a responsibility-oriented chain of command Coordination Control Command

7. Roles and responsibilities in ICS To ensure understanding of the Scope of The Assignment  To ensure understanding of the Chain of Command  Roles and responsibilities in ICS Should   Clearly defined  Rehearsed in drills These roles should be created from the hospital’s Emergency Operations Plan (EOP), which details Who is in charge Which implementation strategy for the appropriate ICS should be installed To ensure understanding of the Scope of The Assignment  To ensure understanding of the Chain of Command  Roles and responsibilities in ICS Should   Clearly defined  Rehearsed in drills These roles should be created from the hospital’s Emergency Operations Plan (EOP), which details Who is in charge Which implementation strategy for the appropriate ICS should be installed

8. THE INCIDENT COMMAND SYSTEM Definition: ICS is an “all-hazard” approach to incident management that is driven by responsibility/position rather than by person ICS is a flexible organizational structure capable of shrinking and expanding based on the size and complexity of the event Definition: ICS is an “all-hazard” approach to incident management that is driven by responsibility/position rather than by person ICS is a flexible organizational structure capable of shrinking and expanding based on the size and complexity of the event

9. History of ICS The foundation for the current ICS was developed in the 1970s by an interagency task force of local, state, and federal personnel Initially, the system was designed to coordinate fire personnel combating large-scale responses, and was developed to correct the myriad of response-related problems that repeatedly were found by the task force analyses of prior major incidents The foundation for the current ICS was developed in the 1970s by an interagency task force of local, state, and federal personnel Initially, the system was designed to coordinate fire personnel combating large-scale responses, and was developed to correct the myriad of response-related problems that repeatedly were found by the task force analyses of prior major incidents

10. These problems included:

11. ICS design is meant to: o Manage all routine, planned events or emergencies, of any size or type, by establishing a clear chain of command o Allow personnel from different agencies or departments to be integrated into a common structure to effectively address issues and delegate responsibilities o Provide needed logistical and administrative support to operational personnel o Ensure key command functions are assigned, and eliminate duplication o Manage all routine, planned events or emergencies, of any size or type, by establishing a clear chain of command o Allow personnel from different agencies or departments to be integrated into a common structure to effectively address issues and delegate responsibilities o Provide needed logistical and administrative support to operational personnel o Ensure key command functions are assigned, and eliminate duplication

12. The Incident Command System (ICS) is based on the premise that every untoward incident or event requires that certain management functions always be performed and managed by trained and experienced personnel Individuals in charge evaluate the problems encountered and write an Incident Action Plan (IAP) for each operational period, i.e., the time required to accomplish a set of objectives The IAP outlines the overarching control and strategic operational objectives established to remedy the identified problems, and determines how needed resources will be managed The Incident Command System (ICS) is based on the premise that every untoward incident or event requires that certain management functions always be performed and managed by trained and experienced personnel Individuals in charge evaluate the problems encountered and write an Incident Action Plan (IAP) for each operational period, i.e., the time required to accomplish a set of objectives The IAP outlines the overarching control and strategic operational objectives established to remedy the identified problems, and determines how needed resources will be managed

13. Please attend!!! The ICS design differs from  That used in the daily administrative structure of the agency or healthcare facility If the usual administrative structure and response practices allow adequate management of the problem  Then an emergency response is not warranted, and an ICS is not required to be activated The ICS design differs from  That used in the daily administrative structure of the agency or healthcare facility If the usual administrative structure and response practices allow adequate management of the problem  Then an emergency response is not warranted, and an ICS is not required to be activated

14. ICS Positions

15. The ICS utilizes standard, functional positions within its organizational structure Not all positions are required for every response Only those positions that have functions necessary in the current situation are activated But disaster manager must be a designated person in charge of each function that becomes operational The ICS utilizes standard, functional positions within its organizational structure Not all positions are required for every response Only those positions that have functions necessary in the current situation are activated But disaster manager must be a designated person in charge of each function that becomes operational

16. The use of the standardized position titles in the ICS structure serves three essential purposes o Reduces confusion within a hospital, or with outside agencies, or other healthcare facilities, by providing a common name for all users o Allows the position to be filled with the most qualified individual rather than by seniority o Facilitates requests for qualified personnel, especially personnel from outside of the hospital o Reduces confusion within a hospital, or with outside agencies, or other healthcare facilities, by providing a common name for all users o Allows the position to be filled with the most qualified individual rather than by seniority o Facilitates requests for qualified personnel, especially personnel from outside of the hospital

17. The Incident Commander Person in charge of the mission The only position that always is activated for an incident (regardless of its nature) The Incident Commander o Defines the mission o Sets all response objectives o Devises strategies and priorities o Maintains overall responsibility for managing the incident o Ensures its completion Person in charge of the mission The only position that always is activated for an incident (regardless of its nature) The Incident Commander o Defines the mission o Sets all response objectives o Devises strategies and priorities o Maintains overall responsibility for managing the incident o Ensures its completion

18. The Incident Commander may choose to activate the following Command Staff positions: o A Public Information Officer Coordinate information sharing with internal personnel and the media o A Safety Officer Monitor operations from a safety perspective and assure the safety of all assigned personnel o A Liaison Officer Serve as the primary contact for external agencies working with the hospital and to coordinate assistance requests to the Local Emergency Operations Center (LEOC) In select situations, the Liaison Officer may be assigned to represent the hospital at the LEOC or at the field Incident Command Post (ICP) o A Public Information Officer Coordinate information sharing with internal personnel and the media o A Safety Officer Monitor operations from a safety perspective and assure the safety of all assigned personnel o A Liaison Officer Serve as the primary contact for external agencies working with the hospital and to coordinate assistance requests to the Local Emergency Operations Center (LEOC) In select situations, the Liaison Officer may be assigned to represent the hospital at the LEOC or at the field Incident Command Post (ICP)

19. Commander, Command Staff and ??? In addition to the Commander and the Command Staff, there are four Sections that comprise specific management functions within an ICS; each is under the direction of an assigned chief who reports to the Incident Commander These positions consist of the: o Operations Section Chief o Planning Section Chief o Logistics Section Chief o Finance/Administration Section Chief Each of these four primary management sections may be subdivided to meet the management demands of the incident In addition to the Commander and the Command Staff, there are four Sections that comprise specific management functions within an ICS; each is under the direction of an assigned chief who reports to the Incident Commander These positions consist of the: o Operations Section Chief o Planning Section Chief o Logistics Section Chief o Finance/Administration Section Chief Each of these four primary management sections may be subdivided to meet the management demands of the incident

20. Operations Section Chief o Responsible for directing all tactical operations (e.g., patient care and facility operations) o Required to carry out the IAP by using the defined response objectives and by directing all needed resources o Responsible for directing all tactical operations (e.g., patient care and facility operations) o Required to carry out the IAP by using the defined response objectives and by directing all needed resources

21. Planning Section Chief Responsible for collecting and evaluating information for  o Decision support o Maintaining resource status information o Preparing documents (such as the IAP) o Maintaining documentation for incident reports Responsible for collecting and evaluating information for  o Decision support o Maintaining resource status information o Preparing documents (such as the IAP) o Maintaining documentation for incident reports

22. Logistics Section Chief Responsible for providing o Support o Resources o Other Services Essential For meeting the response objectives set by the Incident Commander Responsible for providing o Support o Resources o Other Services Essential For meeting the response objectives set by the Incident Commander

23. Finance/Administration Section Chief Responsible for monitoring all costs related to the incident while providing  o Accounting o Procurement o Time recording o Cost analyses To maximize Financial Recovery & Reduce Liability Responsible for monitoring all costs related to the incident while providing  o Accounting o Procurement o Time recording o Cost analyses To maximize Financial Recovery & Reduce Liability

24. ICS Components

25. ICS Component In addition to the Incident Commander, his/her four assistant Command Staff, and the four major functional sections, the ICS may be further divided into organizational components with a distinct title given to those in charge o Divisions o Groups o Branches o Units o Single Resources In addition to the Incident Commander, his/her four assistant Command Staff, and the four major functional sections, the ICS may be further divided into organizational components with a distinct title given to those in charge o Divisions o Groups o Branches o Units o Single Resources

26. Divisions o Used to divide an incident or facility geographically (e.g., first floor) o This command function typically is used among non-hospital response agencies, such as fire and law enforcement authorities o Each Division is led by a Supervisor o Used to divide an incident or facility geographically (e.g., first floor) o This command function typically is used among non-hospital response agencies, such as fire and law enforcement authorities o Each Division is led by a Supervisor

27. Groups o Established to divide the incident management structure into functional areas of operation o They are composed of resources that have been assembled to perform a special function (not necessarily within a single geographical division) o Each Group is led by a Supervisor o Established to divide the incident management structure into functional areas of operation o They are composed of resources that have been assembled to perform a special function (not necessarily within a single geographical division) o Each Group is led by a Supervisor

28. Branches o Created when the number of Divisions or Groups exceeds the recommended span of control (e.g., Medical Care Branch and Service Branch) o Each Branch is led by a Director o Created when the number of Divisions or Groups exceeds the recommended span of control (e.g., Medical Care Branch and Service Branch) o Each Branch is led by a Director

29. Units o Organizational elements that have functional responsibility for a specific Planning, Operations, Logistics, or Finance/Administration activity (e.g., Inpatient Unit, Situation Unit and Supply Unit) o Each Unit is led by a Unit Leader o Organizational elements that have functional responsibility for a specific Planning, Operations, Logistics, or Finance/Administration activity (e.g., Inpatient Unit, Situation Unit and Supply Unit) o Each Unit is led by a Unit Leader

30. Single resources Individual(s) or a piece of equipment with its personnel complement (e.g., perfusionist) or a crew or team of individuals with an identified Supervisor

31. a Task Force a Strike Team

32. a Task Force and a Strike Team The government, the police department, and the fire department may use two other organizational levels not routinely used in the hospital setting o A Task Force o A Strike Team The government, the police department, and the fire department may use two other organizational levels not routinely used in the hospital setting o A Task Force o A Strike Team

33. A Task Force A combination of mixed resources (e.g., an ICU staff of nurses, technicians, and station/unit secretaries) with a common communication capability that is led by a Taskforce Leader

34. A Strike Team A set number of similar resources (e.g., burn nurses) with a common communication capability who operate under the command of a Strike Team Leader Either a Strike Team or Task Force may be sent to assist a healthcare facility that requests personnel with specific expertise during an emergency A set number of similar resources (e.g., burn nurses) with a common communication capability who operate under the command of a Strike Team Leader Either a Strike Team or Task Force may be sent to assist a healthcare facility that requests personnel with specific expertise during an emergency

35. Span of Control (1:3–7) o Individuals in charge can delegate authority to others when necessary, through a chain of command o This allows an effective span of control to be maintained to ensure safety and accountability o The recommended practice for the delegation of authority is to limit personnel management to a ratio of one supervisor to three-to-seven (1:3–7) reporting elements o Individuals in charge can delegate authority to others when necessary, through a chain of command o This allows an effective span of control to be maintained to ensure safety and accountability o The recommended practice for the delegation of authority is to limit personnel management to a ratio of one supervisor to three-to-seven (1:3–7) reporting elements

36. Unified Command Vs.Unity of Command

37. Incident Commander Operation Planning Logistic Finance PIOSafety Liaison