1. NIMS/ICS Introduction National Incident Management System Incident Command System Craig R. Savageau, M.S. HCMG, EMT-P Educator Office of Disaster Preparedness Saint Barnabas Health Care System

2. NIMS/ICS Introduction WHY NIMS? Presidential Decision Directive -5 Presidential Decision Directive -5 Preparedness funding tied to compliance Preparedness funding tied to compliance Executive Order 50 Executive Order 50 JCAHO Environment of Care JCAHO Environment of Care E.C. 1.4 e. Definition of a common (that is, "all-hazards") command structure within the organization for responding to and recovery from emergencies, that links with the command structure in the community. E.C. 1.4 e. Definition of a common (that is, "all-hazards") command structure within the organization for responding to and recovery from emergencies, that links with the command structure in the community. It works! It works!

3. NIMS/ICS Introduction What about HEICS? Hospital Emergency Incident Command System Hospital Emergency Incident Command System A version of ICS/IMS developed for hospitals A version of ICS/IMS developed for hospitals Not specifically NIMS compliance Not specifically NIMS compliance HEICS and ICS have minor differences, defeating the intent of NIMS HEICS and ICS have minor differences, defeating the intent of NIMS Concepts of HEICS can still be used while maintaining NIMS compliance Concepts of HEICS can still be used while maintaining NIMS compliance Job Action Sheets Job Action Sheets

4. NIMS/ICS Introduction History of ICS Developed in the 1970s as a result of devastating wildfires in California Developed in the 1970s as a result of devastating wildfires in California Needed a system to work toward common goals in efficient and effective manner Needed a system to work toward common goals in efficient and effective manner Organizational charts and other techniques taken from business management principles Organizational charts and other techniques taken from business management principles

5. NIMS/ICS Introduction The Incident Command System… IS a system to provide management during emergencies IS a system to provide management during emergencies IS NOT an emergency operations plan IS NOT an emergency operations plan DOES assist in developing an incident specific management structure DOES assist in developing an incident specific management structure DOES NOT replace existing hospital management structures DOES NOT replace existing hospital management structures

6. NIMS/ICS Introduction Without an Incident Management System… CHAOS would result! CHAOS would result!

7. NIMS/ICS Introduction Incident Command System Can be used for any size emergency – large or small Can be used for any size emergency – large or small Uses common terminology and operating procedures Uses common terminology and operating procedures Timely combining of resources during an emergency Timely combining of resources during an emergency System for controlling personnel, equipment, facilities, and communication System for controlling personnel, equipment, facilities, and communication

8. NIMS/ICS Introduction UNDERSTANDING ICS KEY ELEMENTS Common Terminology Common Terminology Modular Organization Modular Organization Management by Objectives Management by Objectives Incident Action Plans Incident Action Plans Manageable Span of Control Manageable Span of Control Predestinated Incident Facilities Predestinated Incident Facilities Resource Management Resource Management Integrated Communications Integrated Communications Establishment and Transfer of Command Establishment and Transfer of Command Unity of command and Chain of Command Unity of command and Chain of Command Unified Command Unified Command Accountability Accountability Deployment Deployment Information or Intelligence Management Information or Intelligence Management Flexibility Flexibility

9. NIMS/ICS Introduction Emergency Operations Center The center formerly know as the The center formerly know as the “Command Center” “Command Center” Emergency Operations Center is the correct NIMS terminology Emergency Operations Center is the correct NIMS terminology

10. NIMS/ICS Introduction Emergency Operating Centers (EOC) The EOC is a pre- designated facility established by an agency to coordinate the overall response and support to an emergency. The EOC is a pre- designated facility established by an agency to coordinate the overall response and support to an emergency.

11. NIMS/ICS Introduction EOC Mission Communication and Intelligence Communication and Intelligence Strategic Direction Strategic Direction Coordination and Documentation Coordination and Documentation

12. NIMS/ICS Introduction When do we activate the EOC?

13. NIMS/ICS Introduction

14. Predesignated Incident Facilities Established by the Incident Commander based on the requirements and complexity of the incident. Established by the Incident Commander based on the requirements and complexity of the incident. Incident Command Post Base Staging Area Base Camp

15. NIMS/ICS Introduction Command Post Dedicated central location Dedicated central location Isolated from noise and other distractions Isolated from noise and other distractions Status board and other visual aids Status board and other visual aids Let people know where it is and how to contact the CP Let people know where it is and how to contact the CP

16. NIMS/ICS Introduction Staging Area An area where resources are kept awaiting assignment An area where resources are kept awaiting assignment May be pre- designated May be pre- designated May be multiple staging areas per incident May be multiple staging areas per incident

17. NIMS/ICS Introduction Incident Facilities: Base Base: Base: Is the location from which primary logistics and administrative functions are coordinated and administered. There is only one Base per incident, and it is designated by the incident name. Is the location from which primary logistics and administrative functions are coordinated and administered. There is only one Base per incident, and it is designated by the incident name. May be collocated with the Incident Command Post. May be collocated with the Incident Command Post. Is established and managed by the Logistics Section. The resources in the Base are always out of service. Is established and managed by the Logistics Section. The resources in the Base are always out of service. Symbol B B

18. NIMS/ICS Introduction Incident Facilities: Camps Camps: Camps: Are where resources may be kept to support incident operations if a Base is not accessible to all resources. Multiple Camps may be used, but not all incidents will have Camps. Are where resources may be kept to support incident operations if a Base is not accessible to all resources. Multiple Camps may be used, but not all incidents will have Camps. Are temporary locations within the general incident area that are equipped and staffed to provide food, water, sleeping areas, and sanitary services. Are temporary locations within the general incident area that are equipped and staffed to provide food, water, sleeping areas, and sanitary services. Are designated by geographic location or number. Are designated by geographic location or number. Symbol C C

19. NIMS/ICS Introduction Tactical Resources Classifications Not available or ready to be assigned (e.g., maintenance issues, rest periods) Not available or ready to be assigned (e.g., maintenance issues, rest periods) Ready for immediate assignment and has been issued all required equipment Ready for immediate assignment and has been issued all required equipment Currently working on an assignment under the direction of a supervisor Currently working on an assignment under the direction of a supervisor Out-of- Service Available Assigned

20. NIMS/ICS Introduction Other Incident Facilities HELISTOP HELISTOP HELIBASE HELIBASE

21. NIMS/ICS Introduction UNDERSTANDING ICS Common terminology ICS uses standardized titles for positions, organizational levels, and facilities ICS uses standardized titles for positions, organizational levels, and facilities Allows for easier communication and organization between agencies Allows for easier communication and organization between agencies

22. NIMS/ICS Introduction UNDERSTANDING ICS Modular Organization Only the parts of the organization chart that are needed for the incident are activated Only the parts of the organization chart that are needed for the incident are activated Positions can stand up, and stand down as needed Positions can stand up, and stand down as needed ICS is designed to expand or contract to fit the needs of the incident ICS is designed to expand or contract to fit the needs of the incident Levels can be added or deactivated depending on the size, scope, and/or nature of the incident Levels can be added or deactivated depending on the size, scope, and/or nature of the incident

23. NIMS/ICS Introduction UNDERSTANDING ICS Span of control Difficult and inefficient for one person to manage too many or too few people Difficult and inefficient for one person to manage too many or too few people In order to maintain span of control, one person should only manage between 3-7 people/units (ideally 5) In order to maintain span of control, one person should only manage between 3-7 people/units (ideally 5) Less than 3 people/units – consider dissolving the supervisory position Less than 3 people/units – consider dissolving the supervisory position More than 7 people/units – an additional level of management should be added More than 7 people/units – an additional level of management should be added

24. NIMS/ICS Introduction UNDERSTANDING ICS Unity of command Each unit or person within ICS should answer to ONE person Each unit or person within ICS should answer to ONE person Multiple superiors can lead to an inability to handle assigned tasks, or leave objectives unattained Multiple superiors can lead to an inability to handle assigned tasks, or leave objectives unattained Staff accountability Staff accountability More effective flow of communication More effective flow of communication

25. NIMS/ICS Introduction Unified Command concept Unified Command concept Senior-level SMEs from different agencies/departments make joint decisions on strategic objectives Senior-level SMEs from different agencies/departments make joint decisions on strategic objectives Each “discipline” has a say in the decision- making process Each “discipline” has a say in the decision- making process Communication and directives flow outward from unified command to various branches in the table of organization Communication and directives flow outward from unified command to various branches in the table of organization UNDERSTANDING ICS

26. NIMS/ICS Introduction Unified Command Continued: Sharing of information, resources, and responsibility to ensure the smooth and efficient delivery of services Sharing of information, resources, and responsibility to ensure the smooth and efficient delivery of services One person (the incident commander) is “in charge” and sets the direction and focus of the group One person (the incident commander) is “in charge” and sets the direction and focus of the group UNDERSTANDING ICS

27. NIMS/ICS Introduction Reliance on an Incident Action Plan Every incident must have an Incident Action Plan (IAP) that: Every incident must have an Incident Action Plan (IAP) that: Specifies the incident objectives. Specifies the incident objectives. States the activities to be completed. States the activities to be completed. Covers a specified timeframe, called an operational period. Covers a specified timeframe, called an operational period. May be oral or written—except for hazardous materials incidents, which require a written IAP. May be oral or written—except for hazardous materials incidents, which require a written IAP.

28. NIMS/ICS Introduction Elements of an Incident Action Plan Every IAP must have four elements: Every IAP must have four elements: What do we want to do? What do we want to do? Who is responsible for doing it? Who is responsible for doing it? How do we communicate with each other? How do we communicate with each other? What is the procedure if someone is injured? What is the procedure if someone is injured?

29. NIMS/ICS Introduction Primary ICS Functions Primary ICS Functions Incident Commander Operations Section Chief Planning Section Chief Logistics Section Chief Finance Section Chief InformationSafety Liaison Command Staff General Staff

30. NIMS/ICS Introduction POSITIONS WITHIN ICS Incident Commander (IC) Overall responsibility for the incident Overall responsibility for the incident Every incident MUST have an Incident Commander Every incident MUST have an Incident Commander First person on scene of an incident should establish a command First person on scene of an incident should establish a command May be replaced by a more qualified person as additional units arrive (Delegation of Authority) May be replaced by a more qualified person as additional units arrive (Delegation of Authority)

31. NIMS/ICS Introduction POSITIONS WITHIN ICS Responsibilities of the Incident Commander Establish scene safety Establish scene safety Request additional resources (if necessary) Request additional resources (if necessary) Establish a staging area Establish a staging area Establish an Incident Command Post Establish an Incident Command Post Set incident objectives and priorities Set incident objectives and priorities Appoint personnel to function in other ICS positions Appoint personnel to function in other ICS positions

32. NIMS/ICS Introduction POSITIONS WITHIN ICS Operations Section Chief Work with the IC to ensure completion of goals Work with the IC to ensure completion of goals Develop tactical objectives Develop tactical objectives Manage units and resources to accomplish the objectives of the incident Manage units and resources to accomplish the objectives of the incident Oversees ICS elements tasked with operations dedicated to resolving and mitigating the incident Oversees ICS elements tasked with operations dedicated to resolving and mitigating the incident

33. NIMS/ICS Introduction Levels of Organization There can be additional levels of organization used under this (or any) section, known as: There can be additional levels of organization used under this (or any) section, known as: Branches Branches Divisions Divisions Groups Groups Task Force/Strike Team Task Force/Strike Team Single Resources Single Resources

34. NIMS/ICS Introduction Incident Commander Operations Section Chief Branch Director Group Supervisor Task Force Strike Team Division Supervisor Task Force Strike Team Branch Director

35. NIMS/ICS Introduction POSITIONS WITHIN ICS POSITIONS WITHIN ICS Branches: Branches: Used to manage assets to help maintain span of control, and are an intermediate management level between the Operations Section and lower levels Used to manage assets to help maintain span of control, and are an intermediate management level between the Operations Section and lower levels Can separate units by function, geography, or any other reason to maintain the span of control Can separate units by function, geography, or any other reason to maintain the span of control Common examples are EMS Branch, Fire Branch, and Law Enforcement Branch Common examples are EMS Branch, Fire Branch, and Law Enforcement Branch Are lead by Branch Directors Are lead by Branch Directors There may be one deputy for each Branch Director There may be one deputy for each Branch Director

36. NIMS/ICS Introduction POSITIONS WITHIN ICS Divisions: Divisions: Established to divide an area geographically Established to divide an area geographically Named to describe the geographic area related to the incident operations Named to describe the geographic area related to the incident operations Lead by a supervisor Lead by a supervisor Not expected to need an assistant Not expected to need an assistant

37. NIMS/ICS Introduction POSITIONS WITHIN ICS Groups: Established to manage a functional area of operations within a branch or a section Established to manage a functional area of operations within a branch or a section Designed according to a specific task they are meant to carry out Designed according to a specific task they are meant to carry out Lead by a supervisor Lead by a supervisor Not expected to need an assistant Not expected to need an assistant

38. NIMS/ICS Introduction POSITIONS WITHIN ICS Single Resource A lone resource, self lead A lone resource, self lead

39. NIMS/ICS Introduction POSITIONS WITHIN ICS Task Force: A collection of different resources tasked with a specific mission A collection of different resources tasked with a specific mission

40. NIMS/ICS Introduction POSITIONS WITHIN ICS Strike Team: A collection of like resources that may be tasked with any mission A collection of like resources that may be tasked with any mission

41. NIMS/ICS Introduction POSITIONS WITHIN ICS Planning Section Responsible for developing short- and long-term plans Responsible for developing short- and long-term plans Collects, evaluates, and displays information about the incident Collects, evaluates, and displays information about the incident Maintains status of equipment and personnel Maintains status of equipment and personnel Maintains incident documentation Maintains incident documentation Led by Planning Section Chief Led by Planning Section Chief

42. NIMS/ICS Introduction POSITIONS WITHIN ICS Planning Section May be broken down into the following units: May be broken down into the following units: Resources Unit Resources Unit Situation Unit Situation Unit Documentation Unit Documentation Unit Demobilization Unit Demobilization Unit Technical Specialists Technical Specialists

43. NIMS/ICS Introduction POSITIONS WITHIN ICS Planning Section Planning Section Each unit is lead by a Unit Leader Each unit is lead by a Unit Leader May have a unit manager assigned to the Leader May have a unit manager assigned to the Leader Not all incidents will require the activation of a Planning Section, or all of the different units - in these cases the responsibilities of the section revert to the IC Not all incidents will require the activation of a Planning Section, or all of the different units - in these cases the responsibilities of the section revert to the IC When there is a Planning Section, but not all of the units are established, those responsibilities fall back on the Planning Section Chief When there is a Planning Section, but not all of the units are established, those responsibilities fall back on the Planning Section Chief

44. NIMS/ICS Introduction POSITIONS WITHIN ICS Logistics Section Responsible for all support and services needed at an incident Responsible for all support and services needed at an incident - Personnel - Facilities - Equipment - Supplies

45. NIMS/ICS Introduction POSITIONS WITHIN ICS Logistics Section Logistics Section This section will be established by the Incident Commander, depending on the needs of the incident This section will be established by the Incident Commander, depending on the needs of the incident May be broken down into two functional Branches: May be broken down into two functional Branches: Service Branch Service Branch Support Branch Support Branch Each of these branches is overseen by a Branch Director Each of these branches is overseen by a Branch Director Each branch can contain three functional units; not all of these units may be required at a specific incident Each branch can contain three functional units; not all of these units may be required at a specific incident

46. NIMS/ICS Introduction POSITIONS WITHIN ICS Service Branch Service Branch Communications Unit Communications Unit Medical Unit Medical Unit Food Unit Food Unit Each unit is lead by a Unit Leader, who may be assisted by a Unit Manager Each unit is lead by a Unit Leader, who may be assisted by a Unit Manager If the Logistics Section is not established, the responsibilities of that section falls back on the Incident Commander If the Logistics Section is not established, the responsibilities of that section falls back on the Incident Commander If the Logistics Section is established, but the two branches are not, the responsibility of each branch falls back on the Logistics Section Chief If the Logistics Section is established, but the two branches are not, the responsibility of each branch falls back on the Logistics Section Chief Support Branch Support Branch Supply Unit Supply Unit Facilities Unit Facilities Unit Ground Support Unit Ground Support Unit

47. NIMS/ICS Introduction POSITIONS WITHIN ICS Finance Section Chief Oversees the Finance/ Administration section Oversees the Finance/ Administration section Usually only utilized at large scale events Usually only utilized at large scale events Responsible for tracking and recording costs and personnel time Responsible for tracking and recording costs and personnel time

48. NIMS/ICS Introduction POSITIONS WITHIN ICS Finance There can be four units established within this section: There can be four units established within this section: Time Unit Time Unit Cost Unit Cost Unit Procurement Unit Procurement Unit Compensation Unit Compensation Unit These units are established based on the particular needs of the incident, as deemed by the Incident Commander These units are established based on the particular needs of the incident, as deemed by the Incident Commander

49. Common Responsibilities

50. NIMS/ICS Introduction Only mobilize to an incident when requested or when dispatched by an appropriate authority. Only mobilize to an incident when requested or when dispatched by an appropriate authority. Make sure that you receive a complete deployment briefing. Make sure that you receive a complete deployment briefing. Mobilization

51. NIMS/ICS Introduction Deployment Briefing Descriptive location and response area Descriptive location and response area Incident check-in location Incident check-in location Specific assignment (e.g., position, team designation, etc.) Specific assignment (e.g., position, team designation, etc.) Reporting time Reporting time Communications instructions (e.g., incident frequencies) Special support requirements (e.g., facilities, equipment transportation and off- loading, etc.) Travel arrangements (if needed)

52. NIMS/ICS Introduction Check-In at the Incident: The check-in process helps to: The check-in process helps to: Ensure personnel accountability. Ensure personnel accountability. Track resources. Track resources. Prepare personnel for assignments and reassignments. Prepare personnel for assignments and reassignments. Locate personnel in case of an emergency. Locate personnel in case of an emergency. Establish personnel time records and payroll documentation. Establish personnel time records and payroll documentation. Plan for releasing personnel. Plan for releasing personnel. Organize the demobilization process. Organize the demobilization process.

53. NIMS/ICS Introduction Check-In at the Incident: Procedures Check in only once at an authorized location: Check in only once at an authorized location: At the Incident Command Post At the Incident Command Post At the Base or Camp(s) At the Base or Camp(s) At the Staging Areas At the Staging Areas At the helibase At the helibase With the Division/Group Supervisor With the Division/Group Supervisor

54. NIMS/ICS Introduction Initial Incident Briefing Current situation assessment and objectives Current situation assessment and objectives Specific job responsibilities Specific job responsibilities Location of work area Location of work area Procedural instructions for obtaining additional resources Safety hazards and required safety procedures/Personal Protective Equipment (PPE), as appropriate Make sure that you receive an initial incident briefing. Make sure that you receive an initial incident briefing.

55. NIMS/ICS Introduction Keep Accurate Incident Records Print or type all entries. Print or type all entries. Enter dates in month/day/year format. Enter dates in month/day/year format. Use military 24-hour time. Use local time. Use military 24-hour time. Use local time. Enter date and time on all forms and records. Enter date and time on all forms and records. Fill in all blanks. Use N/A as appropriate. Fill in all blanks. Use N/A as appropriate. Section Chiefs and above assign a recordkeeper (scribe). Section Chiefs and above assign a recordkeeper (scribe).

56. NIMS/ICS Introduction Be Accountable for Your Actions Maintain chain of command and unity of command. Take direction from a single supervisor. Maintain chain of command and unity of command. Take direction from a single supervisor. Communicate potential hazards and changing conditions using clear text and Plain English. Communicate potential hazards and changing conditions using clear text and Plain English. Act professionally and avoid/report prohibited activities such as: Act professionally and avoid/report prohibited activities such as: Sexual harassment or discrimination. Sexual harassment or discrimination. Use of illegal drugs or alcohol. Use of illegal drugs or alcohol.

57. NIMS/ICS Introduction When Demobilizing (1 of 2) Complete all work assignments and required forms/reports. Complete all work assignments and required forms/reports. Brief replacements, subordinates, and supervisor. Brief replacements, subordinates, and supervisor. Evaluate the performance of subordinates. Evaluate the performance of subordinates. Follow incident and agency check-out procedures. Follow incident and agency check-out procedures. Provide followup contact information. Provide followup contact information.

58. NIMS/ICS Introduction When Demobilizing (2 of 2) Return any incident-issued equipment or other nonexpendable supplies. Return any incident-issued equipment or other nonexpendable supplies. Complete post-incident reports, critiques, evaluations, and medical followup. Complete post-incident reports, critiques, evaluations, and medical followup. Complete any administration issues. Complete any administration issues. Upon arrival at home, notify the home unit (i.e., whoever is tracking you) of your arrival and ensure your readiness for your next assignment. Upon arrival at home, notify the home unit (i.e., whoever is tracking you) of your arrival and ensure your readiness for your next assignment.

59. NIMS/ICS Introduction The Big Picture

60. NIMS/ICS Introduction Let’s Organize! A major sewage leak has occurred in a Med/Surg Unit. A major sewage leak has occurred in a Med/Surg Unit. The unit is full of patients The unit is full of patients The following goals must be achieved: The following goals must be achieved: Evacuate the patients Evacuate the patients Stop the leak Stop the leak Clean up the mess Clean up the mess

61. NIMS/ICS Introduction Let’s Organize Organize the initial response Organize the initial response You have the following personnel You have the following personnel 8 RNs 8 RNs 4 LPN/Nursing Assistants 4 LPN/Nursing Assistants 1 Nurse Manager 1 Nurse Manager 1 Vice President of Operations 1 Vice President of Operations 1 Engineering Manager 1 Engineering Manager 4 Maintenance Staff 4 Maintenance Staff 3 Housekeeping Staff 3 Housekeeping Staff

62. NIMS/ICS Introduction Let’s Organize! Implement the following portions of ICS Implement the following portions of ICS Incident Commander Incident Commander Operations Section Operations Section Branches Branches Groups or Divisions Groups or Divisions What other portions of ICS could be implemented? What other portions of ICS could be implemented?

63. NIMS/ICS Introduction Bonus Problem A small fire has broken out in a patient room A small fire has broken out in a patient room The patient self evacuated the room The patient self evacuated the room Staff was unable to attack the fire, but did shut the door. Staff was unable to attack the fire, but did shut the door. Minor smoke is on the floor affecting some of the patients Minor smoke is on the floor affecting some of the patients

64. NIMS/ICS Introduction Bonus Problem Who is in charge of this incident Who is in charge of this incident initially? initially? next? next? long term? long term? Set up an ICS structure to accomplish the following goals: Set up an ICS structure to accomplish the following goals: Evacuate the floor Evacuate the floor Extinguish the fire Extinguish the fire Triage/ care for patients over come by smoke Triage/ care for patients over come by smoke (outside of the ED) (outside of the ED)

65. NIMS/ICS Introduction

66. For More Information Ryan S. McCormick, BS, NREMT-P Operations Manager Office of Disaster Preparedness rmccormick@sbhcs.com 973 322-4366 NIMS/ ICS Training www.fema.gov/nims