Nursing Home Incident Command System Module 2 Introduction to the Incident Command System This module will introduce you to the principles of incident command that serve as the foundation on which NHICS has been devised.

This program has been produced by the Center for HICS Education and Training with funding from the California Long Term Care Association.  The materials contained within are provided for Nursing Homes and other Long Term Care Facilities in development of emergency preparedness and response programs

Module Objectives Discuss ICS and the three purposes of the Incident Command System (ICS) Outline the fundamental features of ICS Describe the five management functions Define ICS terminology Describe the six steps of the incident planning process The objectives for this module include: - Discuss ICS and the three purposes of the Incident Command System (ICS) - Outline the fundamental features of ICS - Describe the five management functions - Define ICS terminology - Describe the six steps of the incident planning process 3

What is ICS? A standardized, all-hazard approach to incident management; usable to manage all types of emergencies, routine or planned events, by establishing a clear chain of command ICS ensures Safety of responders and others Achievement of tactical objectives Effective use of resources It is important to understand that ICS is a management system—not an organizational chart. It is predicated on a number of principal tenets: • Every incident or event requires that certain management functions be performed. The problem encountered is evaluated, a plan to remedy the problem identified and implemented, and the necessary resources assigned. Management by objective (MBO) is thus a critically important component to the successful implementation of an incident command system and involves the inclusion of both control and operational period objectives. 4

Fundamental Features of ICS Common terminology Modular organization Management by objectives Reliance on an Incident Action Plan (IAP) Manageable span of control Pre-designated incident locations/facilities Resource management Integrated communications Common command structure It is recognized that long term care nursing homes, whether the distinction is nursing homes long term, residential care, skilled nursing facility or others, come in a variety of sizes and delivery services. Therefore the NHICS guidance is developed from a minimal, standard and optimal approach, acknowledging the limited resources sometimes available for response. Regardless of the size or complexity of the nursing home or LTC facility, the fundamental features of ICS remain important premises. 5

Management Functions Command Operations (Doers) Planning (Planners) Logistics (Getters) Finance/Administration Command Operations Planning Logistics Administration Finance/ The ICS organization frequently does not correlate to the daily administrative structure of the agency or facility hospital. This practice is purposeful and done to reduce role and title confusion. Those positions activated in the response come together to serve as the Incident Management Team (IMT), whose purpose is to respond to and recover from the event through coordinated objectives and tactics. Position titles within the IMT should remain unchanged; this promotes interoperability between response partners, allowing for sharing of personnel resources among organizations. The IMT structure consists of the command and general staff, with sections clearly identified by the roles and responsibilities they carry out. These roles will now be discussed in further detail. 6

Command Only position always activated in an incident regardless of its nature Sets the objectives, devises strategies and priorities Maintains overall responsibility for managing the incident The IC is the only position that is always activated. The Incident Commander activates and directs the response through the development of command objectives to direct the response. In many cases, the Incident Commander may be the only position that is activated. A critical responsibility of the Incident Commander is the decision to evacuate the facility. Based on the incident hazard that causes evacuation, this can be a difficult decision and is based on overall situational information, the projected impact, the threat to life and property, and the capability for safe evacuation. 7

Operations Conducts the tactical (“doing”) operations Carries out the plan using defined objectives Directs all needed resources Many incidents that likely will occur involve injured or ill patients. The Operations Section will be responsible for managing the command and control objectives outlined by the Incident Commander. What are you trying to say here? Even if we don’t have injured patients, we will still need to have operations to meet the needs of the patients The Operations Section consists of 4 positions. Oversight of the Section is by a Chief. Additional positions that may be activated include a Staging Area Manager, Medical Care Branch Director, and Infrastructure Branch Director. Further detail of each position and it’s responsibilities will be discussed in module III Give examples of what they do 8

Planning Collects and evaluates information for decision support Maintains resource status Prepares documents such as the Incident Action Plan Maintains documentation for incident reports When sufficient staff are available, and when the impact of the event is sustained, the Planning Section may be activated under the Optimal IMT Chart. The role of the Planning Section within the NHICS Incident Management Team is to gather and validate information from both internal and external sources. The Planning Section must also gather and track situational response data, providing up to date and accurate information regarding residents, supplies and equipment and other resources, projected the ability to sustain operations based on the current and future status. Additional positions that may be activated under the planning section include the Situation Unit Leader and the Documentation Unit Leader dependant on need 9

Logistics and Finance/Administration Provides support, resources, and other essential services to meet the operational objectives Finance/Administration Monitors costs related to the incident Providing accounting, procurement, time recording, and cost analyses The Logistics Section oversees the provision of services and support to sustain current operations and the operational response to the incident. This includes personnel / manpower, supplies, equipment, pharmaceuticals and vehicles. The Logistics Section works closely with the Operations Section, responding to supply requests and their acquisition based on the needs of the response. There are two additional branches that may be activated under the logistics section: Service and Support which will be discussed in further detail in Module 3 The Finance Section oversees the costs and expenditures incurred by the response actions, including the purchasing of supplies and equipment. The Finance Section must also account for lost revenue associated with the response and recovery. There are three additional positions that may be activated under the Finance Section Chief; Time Unit Leader, Procurement/Cost Unit Leader and the Claims Unit Leader. 10

Common Terminology Provides for a clear message and sharing of information Avoids use of codes, slang, and/or discipline specific nomenclature Defines the common organizational structure Facilitates the ability to share resources Common terminology helps to define the common organizational structure; as an example, the identification of sections, section chiefs and branch directors. Another key benefit of common terminology is the ability to share resources in the response, such as personnel to oversee incident management or operations. By using consistent terminology, the opportunity to develop memorandums or agreements to share personnel is enhances. 11

Modular Organization ICS structure begins from the top and expands as needed by the event Positions within the structure are activated as dictated by the incident size and complexity Only those functions or positions necessary for the incident are activated Give example of a large and small event. Simple power out for 4 hours - Incident Command activated – power outage plan put in place – provide routine care – no need for staff or $ Earthquake with damage to facility - Incident Command activated - operations assessing resident care - logistics evaluating facility damage and getting fuel and vehicles if needed - finance tracking costs 12

Management by Objectives Incident Commander initiates the response and sets the overall command and control objectives Objectives are established after an assessment of the incident and resource needs are completed Clearly defined objectives allow staff to focus on the response and avoid duplication of effort The Incident Commander initiates the response and sets the overall command and control objectives. The mission of the response is defined for all members of the response team through a clear understanding of the organization’s policy and direction. This includes an assessment of the incident from the current situation to projected impacts. To meet the overall mission, or command objectives, individual sections will establish incident objectives as well as the strategies to achieve these objectives through clear tactics. Because emergency response is not business as usual, clearly defined objectives will allow staff to focus on the roles in the response, avoiding duplication of efforts or omission of critical actions. Use the examples that were given on previous slide (modular organization) to show what and how management by objectives would work, again give some solid examples 13

Incident Action Planning Development of objectives is documented in the Incident Action Plan (IAP) Reflects the overall strategy for incident management Forms tailored for nursing homes to support the IAP process The development of objectives is documented in the incident action plan. A written plan provides personnel with direction for taking actions based on the objectives identified in the IAP and reflects the overall strategy for incident management while providing measurable strategic operations for the operational period. To ease this process, ICS forms tailored to nursing homes have been developed and are contained within the NHICS guidebook. 14

Manageable Span of Control Maintains a span of control which is effective and manageable Optimum span of control is 1 supervisor to 5 reporting personnel 1 2 3 4 5 A key concept in ICS is maintaining a span of control that is both effective and manageable. Because emergency events are not “business as usual” situations, the span of control for operations that are not routine should be kept at an effective number. Within ICS, the optimum span of control is 1 supervisor to 5 reporting personnel. If the number falls outside these ratios, the incident management team should be expanded or consolidated. 15

Pre-designated Incident Locations/Facilities Location of response and coordination sites should be pre-planned Planners within the nursing home should identify sites for ICS management, staging areas for the receipt of supplies and equipment, and evacuation sites if required In the planning stages, planners should determine the location of their response and coordination sites, including the coordination and command sites such as the NH Command Center. Within ICS, sites are identified for both scene and regional coordination, such as helicopter landing zones, staging areas, command posts, and emergency operations centers. Planners within the nursing home or long term care facility should identify sites for ICS management, staging areas for receipt of supplies and equipment, evacuation sites if the infrastructure is unsafe, etc. 16

Resource Management Resources used are categorized as tactical and support Tactical; include personnel, major equipment available or potentially available Support; those items which support the incident, such as food, equipment, communications, supplies, vehicles Knowledge of the available tactical and support resources is critical to the success of the response Resources used in the response are categorized as tactical and support. Tactical resources include personnel and major equipment available (ventilators, generators, NPU units, etc.) or potentially available for use in the response. Support resources are all other resources to support the incident, including food, equipment, communications, supplies, vehicles, etc. It is critical in the response to understand the availability and status of both tactical and support resources. It is important to have a clear picture of current and needed resources when working within the medical mutual aid system in the jurisdiction or state, allowing those providing the response support to provide the necessary assets through a clear understanding of current capability. 17

Integrated Communication Three elements within integrated communications: Modes; hardware systems that transfer information, i.e. radios, cell phones, pagers, etc Plans; should be developed in advance on how to best use the available resources Networks; should be identified within and external to the nursing home This will determine the procedures and processes for transferring information internally and externally There are three elements within integrated communications: modes, plans and networks. The modes include the hardware systems that transfer information, such as radios, cell phones, pagers, etc. Plans should be developed in advance on how to best use the available modes through clear and concise communication policy and plans. For example, determining who can use radios and what information should be communicated. The networks identified within the jurisdiction will determine the procedures and processes for transferring information internally and externally 18

Common Command Structure Structure that identifies the core principles for an efficient chain of command Unity of Command states that each person within the response reports to only one supervisor Single Command exists when only a single agency or discipline responds ICS provides for a common command structure that identifies core principles for an efficient chain of command. Unity of Command dictates that each person within the response structure reports to only one supervisor. A single command exists when a single agency or discipline responds to an event; for example, the fire service at a warehouse fire is commanded by a fire captain or chief. When multiple agencies or disciplines are working together at a scene, there is a unified command structure that allows for coordination in response actions. For nursing homes, this may occur when the facility is the scene of the incident, such as a fire. The nursing home administration and the fire command work together in a unified command structure. 19

Six Steps to the Incident Planning Process Understand the policy and direction Assessing the situation Establishing incident objectives Determining appropriate strategies to achieve the objectives Providing tactical direction and ensuring that is followed Example: The correct resources assigned to complete a task and their performance monitored Providing necessary back-up Assigning more or fewer resources Changing tactics In developing the response to the event, certain steps should be taken to guide the response. These steps are part of Incident Action Planning which is comprised of six steps. The incident planning process is a core concept of ICS and takes place regardless of the incident size or complexity. Further discussion of the Incident Planning Process will be described in Module IV 20

Key Points Review Benefits of ICS are: Manages routine or planned events Establishes a clear chain of command Provides a common structure and common terminology Ensures key functions are covered and eliminates duplication Manageable and scalable to the scope and magnitude of the incident Incident Commander always activated Other positions activated as needed

Module 2 Self Evaluation Questions The Incident Command Structure____ Is only applicable in governmental settings. Is a standardized, all-hazard approach to incident management. Can only be used in large facilities and institutions. Is only used on large events

Module 2 Questions 2. Which of the following is NOT a purpose of ICS? a. Safety of responders and others b. Achievement of tactical objectives c. Effective use of resources d. A way to learn a new job

Module 2 Questions 3. Fundamental features of ICS include: a. Common terminology, management by objectives, common command structure b. Common terminology, management by objectives, staff function in normal daily roles c. Management by objectives, common command structure, large organizational chart where all roles must be filled d. Short phrases, small number of positions

Module 2 Questions 4. The five management functions of ICS are: a. Administrator, DON, Admitting, Dietary, Environmental b. Fire Chief, EMS Chief, DOH, Mayor, Hospital Administrator c. Command, Operations, Logistics, Planning, and Finance/ Administration d. Command, Operations, DON, Planning, Finance

Module 2 Questions 5. Which is not part of the six-step incident planning process? a. Assessing the situation b. Establishing incident objectives c. Determining appropriate strategies to achieve the objectives d. Determining which restaurant delivers after hours e. Providing tactical direction