Incident Management for Healthcare

Incident Management for Healthcare
Based upon Emergency Management Institute ICS- HC The target audience is hospital providers that will assume any level of leadership within the healthcare facility during an emergency ( will occupy a box on the incident organizational chart).

Minnesota Emergency Readiness Education and Training Program (MERET)
MERET worked with partners in Minnesota to adapt curriculum to support the Hospital Incident Command System (HICS) training MERET is a program designed to educate and train Minnesota’s health care workers in emergency preparedness, tailoring efforts to the unique needs of specific communities as they prepare for a health emergency or bioterrorism event. MERET is funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services, and is administered by the University of Minnesota Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN, at the School of Nursing, is the Principal Investigator. Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum Development Program.

Objectives Name the four (4) phases of comprehensive incident management. Recognize how objectives shift from the initial response phase to the extended response phase. Name the order in which the Hospital Incident Command System (HICS) is usually activated. Select the forms used by the Command and General Section Chief staff. Identify the role of the Incident Commander. Select the appropriate span of control for any leadership position in the HICS. Identify the purpose of the Incident Briefing. The ICS offers a standardized emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents without being hindered by jurisdictional boundaries ICS is the combination of facilities, equipment, personnel, procedures and communications operating within a common organizational structure, designed to aid in the management of resources during incidents. ICS is used by various jurisdictions and functional agencies, both public and private, to organize field-level incident management. This curricula incorporates the framework of the Hospital Incident Command System (HICS) with materials from FEMA Federal Emergency Management Agency Institute’s ICS100HC course for healthcare providers.

What is the Hospital Incident Command System (HICS)?
Created in the 1980’s as Hospital Emergency Incident Command System (HEICS) and Evolved to HICS as a comprehensive incident management system for both emergent and non-emergent situations . Foundation for more than 6,000 hospitals in the United States to prepare and respond to disasters Hospital are seen as essential members of community preparedness and are recognized as “first responders” in emergency response. The HICS provides a common structure and language for promoting interagency communication based on functions Evolved from an Incident Command System (ICS) used by multiple agencies to manage events The Hospital Emergency Incident Command System (HEICS) was created in the 1980’s and evolved to HICS as a comprehensive incident management system for both emergent and non-emergent situations. The structure is a foundation for more that 6,000 hospitals to assist with their emergency planning and response efforts for all hazards. Hospitals are seen as community partners and first responders for all hazard incidents that occur in a community HICS is a management system that provides common structure, terminology to promote interagency communication based on functions

Incident Command System (ICS) History
FIRESCOPE – 1970s NIIMS (National Interagency Incident Management System) NIMS (National Incident Management System) MnIMS (MN Incident Management System) OSHA (Occupational Safety and Health Administration NFPA 1600 (National Fire Protection Association) The Joint Commission (formerly JCAHO) Requires healthcare facilities to use community-congruent IMS The Incident Command System was developed in the 1970’s by an interagency task force working in cooperation with local, state, and federal efforts to combat wildland fires. Firefighting Resources of Southern California Organized for Potential Emergencies (FIRESCOPE) was created in 1972 after a disastrous 1970 wildfire consumed 600k acres and 772 structures in 13 days, 16 deaths in Southern California. The goal of this group was to create and implement new applications in fire service management, technology and coordination, with an emphasis on incident command and multi-agency coordination. This dynamic state-wide program continues to serve the needs of the California Fire Service today. NIIMS has been developed to provide a common system that emergency service agencies can utilize at local, state and federal levels. NIMS was developed so responders from different jurisdictions and disciplines can work together better to respond to natural disasters and emergencies including acts of terrorism. NIMS benefits include a unified approach to incident management; standard command and management structures; and emphasis on preparedness, mutual aid and resource management. MnIMS (MN Incident Management System, originally named MIMS) MN has used the MnIMS to accomplish the same goals as that of the NIMS. The MnIMS is designed to be used from the time an incident first occurs until the requirements for management no longer exist. The structure can be established and expanded depending on the changing conditions of the incidents OSHA is the main federal agency charged with the enforcement of safety and health legislation. NFPA 1600 was the 1st document created by the Disaster Management Committee in January California then looked at the hospital command structure and recognized a need to operate as their firefighter counterparts. NFPA 1600 provided a standardized basis for disaster/emergency management planning and business continuity programs in private and public sectors by providing common program elements, techniques and processes. The Joint Commission, formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO, pronounced "jay-co“, renamed in 2006), is a US-based non-profit organization formed in 1951 with a mission to maintain and elevate the standards of healthcare delivery through evaluation and accreditation of healthcare organizations. The Joint Commission employs surveyors who are sent to healthcare organizations to evaluate their operational practices and facilities. Historical progression JCAHO as of 2001, HSPD 5 in 2003, NIMS announced 2004, Modification of wild land National interagency incident management system (NIIMS).

What is the Hospital Incident Command System (HICS)?
Created in the 1980’s as Hospital Emergency Incident Command System (HEICS) and Evolved to HICS as a comprehensive incident management system for both emergent and non-emergent situations . Foundation for more than 6,000 hospitals in the United States to prepare and respond to disasters Hospital are seen as essential members of community preparedness and are recognized as “first responders” in emergency response. The HICS provides a common structure and language for promoting interagency communication based on functions Evolved from an Incident Command System (ICS) used by multiple agencies to manage events The Hospital Emergency Incident Command System (HEICS) was created in the 1980’s and evolved to HICS as a comprehensive incident management system for both emergent and non-emergent situations. The structure is a foundation for more that 6,000 hospitals to assist with their emergency planning and response efforts for all hazards. Hospitals are seen as community partners and first responders for all hazard incidents that occur in a community HICS is a management system that provides common structure, terminology to promote interagency communication based on functions

Homeland Security Presidential Directives (HSPDs)
Management of Domestic Incidents HSPD-5 HSPD-8 National Preparedness Mandates In the wake of , President Bush issued Homeland Security Presidential Directives HSPDs to assure more integrated response systems from the local to the federal level. HSPD-5 Identifies steps for improved coordination in response to incidents. It requires the Department of Homeland Security to coordinate with other federal agencies and State, local and tribal governments to establish a National Response Plan (NRP) and a national incident management system, (NIMS) HSPD-8 Purpose is to establish policies to strengthen the preparedness of the United States to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other emergencies. This directive establishes a national domestic all-hazards National Preparedness Goal, establishing mechanisms for improved delivery of Federal preparedness assistance to State and local governments. Together the NIMS, the NRP and the National Preparedness Goal define what needs to be done to prevent, protect against, respond to and recover from a major event, how it needs to be done, and how well it needs to be done. National Incident Management System (NIMS) National Response Plan (NRP) National Preparedness Goal Slide courtesy of FEMA

National Incident Management System/Components (NIMS)
NIMS: Standardizes incident management processes, protocols, and procedures for all responders. Mandates ICS Command and Management ICS Multi-Agency Coordination Public Information Systems Preparedness Resource Management Communications and Information Mgt. Supporting Technologies Ongoing management and Maintenance NIMS, Provides a consistent framework for incident management at all jurisdictional levels regardless of the cause, size, or complexity of the incident. Building upon the Incident Command System (ICS) the NIMS provides the Nations’ first responders and authorities the same foundation for incident management for terrorist attacks, natural disaster, and other emergencies. NIMS requires that ICS be institutionalized NIMS is often thought of as an organizational scheme for incident command In addition to standardizing ICS, NIMS emphasizes multi-agency coordination, whereby agencies work across jurisdictional or other boundaries to develop policy, share information, and analyze event data. Public information systems refer to processes, procedures and systems for communicating timely, accurate and consistent information to the public during crisis. Joint Information Centers (JIC) are where agencies develop and distribute joint messages to the public and providers. Preparedness strategies involve integrated planning, training & exercises well in advance of any potential incidence. Resource management is the use of resource categorization and management systems to assure the right resources to the right place at the right time are emphasized. Communications and information management is the standardized framework for communications, information management and information sharing at all levels of incident management. Supporting technologies are systems that support interoperability between agencies such as voice, data management technologies Slide courtesy of FEMA

National Response Plan
Establishes . . Incidents occur and are managed at the lowest level Provision of federal aid to support state and local efforts as requested. Unified, all-discipline, all-hazard, management approach Under Directive HSPD-5, the President directed the Department of Homeland Security to develop a new National Response Plan. This plan is based upon the belief that incidents are generally handled at the lowest possible geographic, organizational and jurisdictional level possible. The NRP includes a section that summarizes the roles and responsibilities of State, local, tribal, and private-sector entities in the context of domestic incident management. In the vast majority of incidents, State and local resources and interstate mutual aid will provide the first line of emergency response and incident management support. When State resources and capabilities are overwhelmed, Governors may request Federal assistance. The NRP provides the framework to align Federal coordinating structures, capabilities, and resources into a unified, all-discipline, and all-hazards approach to domestic incident management to ensure timely and effective Federal support.

NIMS & NRP Relationship
National Incident Management System (NIMS) Standardized process and procedures for incident management NIMS aligns command & control, organization structure, terminology, communication protocols, resources and resource typing Incident DHS integrates and applies Federal resources Local Support or Response Resources, knowledge, and abilities from all Federal agencies State Support or Response MERET staff flipped the original FEMA triangle upside down (supported by input from Greater MN Focus Group) NIMS is an incident management system which is congruent between ALL levels of response and thus ensures standard terms are used. ALL response begins locally and breakdowns in communications, incident management, information sharing, and resource requests will be reflected to all the levels above where they occur (and usually magnified!) Department of Homeland Security integrates Federal resource response (though it may not be as clean as the puzzle here!) via the National Response Plan. Federal Support or Response NRP is activated for Incidents of National Significance National Response Plan (NRP) Activation and proactive application of integrated Federal resources & NRP Relationship

Weaknesses prior to ICS
Lack of accountability Poor communication Lack of planning process Overloaded commanders Interagency integration – ICS purposely does not reflect agency-specific titles, etc. to avoid confusion KEY POINT - Most of the time it is NOT a lack of resources, it is a lack of coordination that is the problem – resource shortages are rarely the problem. Also, since ICS is a position, and not person dependent, instead of waiting for the hospital CEO to arrive, positions are handled by the best qualified person available at the time and then handed off as needed… Even under the ICS structure we are still learning lessons of interagency integration. Example after Hurricane Katrina there were local, state, regional, federal coordination issues. The MN response to a possible influx of refugees from Hurricane Katrina was very fast. Within 72 hours, Little Falls was set up as a place to take refugees from Katrina. Lessons were learned from merging military command and a civilian command operation operating in the same incident ICS command system. The more we work on it, the more prepared we will be.

Tiered Response Strategy
Capabilities and Resources Federal Response State Response Regional / Mutual Response Systems Local Response, Municipal and County Note that local communities are on their own for the first hours and that Federal response is NOT ‘first response’ – assume it will be days before there is a Federal resource presence. In some cases, there will be no assets coming (pandemic flu). The Federal Response should be thought of as an augmentation or replacement response and a RECOVERY response rather than a crisis response. During the life safety period of the response there will be no Federal assets available to the jurisdiction unless they were pre-positioned – you will have what you have. Minimal Low Medium High Catastrophic Increasing magnitude and severity 'Medical Surge Capacity and Capability Handbook' by J. Barbera and A. Macintyre published by CNA Corporation.

Hospital Incident Management
Let’s talk about incident management at the hospital level… Facility Response Local Response State Response Federal Response The following slides will present examples of levels of response This slide may be replaced with a picture of your own facility

What is meant by an “incident” in the Incident Command System?
. . . an occurrence, either caused by human or natural phenomena, that requires response actions to prevent or minimize loss of life, or damage to property and/or the environment. Incident as define in the ICS is an occurrence, either caused by human or natural phenomena, that requires response actions to prevent or minimize loss of life, or damage to property and/or the environment RARELY confined to single agency – thus importance of inter-operability / integration of response in order to assure that the response is coordinated and that the right information is shared to make the right decisions Even a ‘simple’ house fire involves EMS, fire, law enforcement, often outside agencies (utilities, natural gas), and information processing (wind direction, weather, site hazards, access, staging )where the resources will be positioned that will be moved into the scene as needed), etc. As a local incidence evolves to include regional, state and federal and other agencies, the importance of interoperability is even more critical. Photos courtesy of FEMA Photos courtesy of FEMA

What is a ‘disaster’? A disaster is when the demands of an ‘incident’ outstrip available resources Goal: Get the… Right stuff / staff to the Right place at the Right time to prevent an incident from becoming a… DISASTER Incident management is the key! ICS will help you make the best use of your resources so that you can, in most situations, avoid a ‘disaster’. Incident management MUST be used in more routine circumstances for personnel to become comfortable with its use. This practice will avoid a “disaster within a disaster” during an incident. We will talk more about this as we go on

Le Sueur Tornado Discuss the impact of a tornado on a community –
What if it takes out the hospital or local nursing home? If it doesn’t take out the hospital, the impact on the hospital will be short What if it takes out a school? Is the expected effect on the healthcare system brief or prolonged? (brief – some delayed injuries during clean-up, etc. but impact is usually immediate). Photographer: D. Burgess. Photo courtesy of NOAA Photo Library

Red River Flood Photographer: David Saville, Photos courtesy of FEMA
One example of a multi-agency response in a disaster would be the Red River Flooding in Disaster declared on April 8, Estimated local cost $26.0 million. Local Dike building Fires, flooding Evacuation efforts Search and rescue Regional Red Cross, Salvation Army Since one of the medical facilities was destroyed, alternative care sites were set up at other locations State National Guard called to assist dike building, and evacuation efforts Refugee base set up at Grand Forks Air Force Base Federal FEMA constructed temporary Metal buildings for schools Trailers for housing FEMA grants for rebuilding President Clinton toured the area and promised that the cities would have access to programs that would “rebuild the cities stronger and better than ever”

Planning for healthcare facility disasters is complicated by the fact that transportation resources to assist with the evacuation may be non-existent, and the facility may be remote from other hospitals. This issue emphasizes the need (especially in remote areas) to plan for alternate care sites or sheltering plans awaiting evacuation. Communications and records MUST be able to move off-site as part of continuity of operations planning so that the evacuation and follow-up activities can occur. Photographer: Mark Wolfe, Photo courtesy of FEMA

Emergencies Present In 2 Ways…
Unanticipated and/or Without Warning Anticipated and/or With Warning Oklahoma City Bombing Hurricane Katrina Tornado Midwest Floods Northridge Earthquake Pandemic Flu Critical – Events with warning times give us an opportunity to be proactive Without warning, people have trouble mobilizing If you can get your ICS up and running and get into a planning cycle prior to or as the event is getting started you will be FAR better off as you can BEGIN in a proactive mode and have much better situational awareness than if you have no warning time. The Amount of Time We’re Given To Pre-Organize People and Pre-Stage Equipment Can Drastically Change Our Response Effectiveness Illustration courtesy of Pete Brewster – VA Medical System

Slide courtesy of John Hick Hennepin County Medical Center
Incident progression Reactive Phase Recognition Notifications Initial control and safety actions Establish ICP Primary Tools SOPs Job Action Sheets Primary Goal Prevent incident expansion Prevent responder injury Proactive Phase Situation assessed Objectives established Strategies / tactics Resources requested Primary Tools ICS Incident Action Planning Primary Goal Manage incident BOOM! BOOM – Unexpected event happened: explosions, train derailments, tornados, ice storms Incidents without warning have two phases: Reactive -taking initial steps to assure life safety, notify the proper authorities, evacuating the area, etc. use facility Standard Operating Procedures (SOPs), hospital specific policies and procedures Proactive -step back, assess the situation, and begin to manage it rather than just continue to react to it – get ahead of the situation and anticipate staff, space, and supply needs Life safety is ALWAYS the first priority and the first objective should be to assure life safety and safety of our patients and staff. The person in charge at the time of the incident must assume command and size up the situation. Gather personnel who are available to discuss priorities and immediate objectives Proactive Phase Follow Emergency Operational Plans Recognition of event Initial notifications Initial control and safety actions Shift from reactive to proactive Proactive Establish Incident Command Post Gather personnel who are available to discuss priorities Choose a safe location for the ICP that allows for expansion if additional command or general staff are added Slide courtesy of John Hick Hennepin County Medical Center

Incidents Require you to …..
Incidents require you to pull the group together Get your “Ducks in a row” “Huddle up!” Get organized Get in position to ‘manage’ Establish Incident Command Post

School Shooting The Red Lake School Shooting is an example of how a hospital worked within their incident command structure in an incident which progressed from reactive to proactive: Shortly before 3:00 pm, on March 21, 2005, a student entered the Red Lake High School, Red Lake, MN and started shooting. In less than 10 minutes 15 people were shot with 8 deaths including the shooter. EMS arrived on the scene and began to treat victims, established patient triage and transported patients to the Red Lake Hospital. The hospital immediately activated HEICS Hospital Emergency Incident Command System (now Hospital Command System HICS) and went into lock-down. All victims were taken to the Red Lake Hospital for initial evaluation. North Country Regional Hospital in Bemidji received notification of the shootings shortly after 3:00 pm and began to prepare to receive patients from the shootings. The hospital went into lock-down. With the aid of Beltrami County Emergency Management, North Country regional hospital instituted perimeter traffic control measures. EMS mutual aid agreements were activated from surrounding communities to assist in the transportation of patients from Red Lake to Bemidji. The hospital compact was also activated in surrounding hospitals for the purpose of diverting other emergency patients not associated with the shootings and replenishing supplies and equipment The MeritCare Urgent Care Clinic in Bemidji extended its hours to help with routine medical emergencies in Bemidji. Regional health notification was initiated with the aid of the “Red Book” - a listing of regional and local contact numbers for public health and healthcare organizations for northwestern MN. (Information from MN Department of Health-Office of Emergency Preparedness) Image courtesy of FEMA, Photographed by Jocelyn Augustino

What is an Incident Command System (ICS)?
Provides framework to: Identify and assess the problem Develop plan to deal with the problem Implement the plan Procure and pay for necessary resources A structured system for controlling: Personnel Facilities Equipment Communications Preparedness planning Can and does help lessen the shock of a disaster Allows responders to react more effectively and efficiently Photographer: Jocelyn Augustino, Photo courtesy of FEMA

Why use ICS? Greater efficiency in managing internal or external crisis incidents of any kind or size Better coordination and communication within and external to facility Standardization and flexibility which allows personnel from different organizations to use a common management structure To provide logistical & administrative support to ensure that operational staff can meet tactical objectives To be effective in reducing costs by avoiding duplication of efforts Stress common terminology with public safety, management by objectives, structured response. Note that flexibility is critical, as the demands of a disaster wax and wane, and no event is the same. In February 2004, all metropolitan public health departments and several state agencies including the MN Dept. of Health participated in Snowball II exercise to address public health..They tested risk communication, epidemiological response, incident command, Strategic National Stockpile related activities, mass dispensing, Health Alert Networks and overall coordination between state and local health departments. Mission Mode Solutions Corporation provided an internet-based communication system that allowed over 400 participants from multiple response agencies to communicate during the exercise period. While there was no actual on-the scene response, the exercise played out in a manner more consistent with a real-life response than would a typical tabletop exercise (Information from MN Department of Health-Office of Emergency Preparedness) Photographer: Marvin Nauman, Photo courtesy of FEMA

When should ICS be used? ANY incident that requires something OTHER than day-to-day organizational structure and function (e.g.: special event planning) Utility of ICS depends on frequent use in order to maintain familiarity with structures/function No correlation between the ICS organization & administrative agency structure; every incident requires different management functions Though generally we only use ICS to deal with problems that we CANNOT MANAGE USING USUAL DAY-TO-DAY operations. ICS should be in place for all planned events. ICS could be used for special event planning such as, transition to a different medical record, community celebrations,…air shows, parades, eel pout; We Fest; Oktoberfest; high school sports tournaments. A good plan assists in the management of an unexpected turn of events and minimizes the impact of the incidence If things go bad you are already in the mode (proactive phase) Examples In 2006 at the Oshkosh Air Show when the propeller of a Navy Warbird sliced into a home-built airplane on a taxiway during the air show. 1998 Minneapolis HOLIDAZZLE PARADE Joyous event turned tragic when a city-owned police van crashed into a crowd of parade spectators at the Holidazzle parade in downtown Minneapolis. 2 people were killed and several others seriously injured. Insert own local story. Fire services and public safety use IMS EVERY DAY…practice means better ability to flex up and down. Every incident requires different management functions

Incident Command System (ICS) Features…
Common Terminology Modular Organization Management by Objectives Reliance on an Incident Action Plan (IAP) Chain of command & unity of command Unified Command Manageable span of control Pre-designated incident locations & facilities Resource Management Information & Intelligence Management Integrated Communications Transfer of Command Accountability Mobilization By the end of this presentation, you should be able to describe these basic features of the Incident Command System and the tools and ICS forms used in the application of this process. Slide courtesy of FEMA

IMS Feature: Common Terminology
Common terminology must be used! Plain English (not codes) Ensures efficient, clear communication Position titles, not person (e.g.: operations chief, not ‘nursing supervisor’) – titles are a common standard for all users Resource typing – ‘tanker’ Facility terminology – ex. ‘command post’ ‘command center’ LIMIT what you say to essential info Ask for examples – ’10’ codes, etc. what about ‘tanker’? For most of us, that’s a gasoline truck, for fire services it is a water-hauling and pumping truck, for air services it is a water-hauling plane, etc. This is why resource typing is critical. Facility terminology – command post, etc. Many hospitals use ‘codes’ for overhead paging – is there a reason that they have to be used? Could more be in plain English? Slide courtesy of FEMA

Basic ICS Structure –Modular Organization
The ICS Modular Organization structure follows “form follows function philosophy” which means that an organization at any given time should reflect only what is required to meet planned objectives This is the basic structure common to ALL Incident Management Systems (sometimes known as the CFLOP diagram) Commander, Logistics, Operations, Finance & Planning Incident Commander (IC) provides overall leadership for incident response. The following slides will identify the roles and responsibilities of these officers and sections Slide courtesy of FEMA

Incident Commander The Incident Commander performs all major ICS command and staff responsibilities unless delegated and assigned. Public Information Officer Command Staff Incident Commander Liaison Officer Incident Commander Incident Commander can delegate responsibilities as needed during an event. The Command Staff includes a Public Information Officer, Liaison Officer and Safety Officer. If they don’t delegate it, they are responsible for it. Safety Officer General Staff Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief Slide courtesy of FEMA

Incident Commander Only position always staffed
Ensures safe work practices Provides overall leadership for incident response Initial IC holds post until they delegate the post to another qualified/more qualified person Demonstrates initiative by taking action Motivates responders Communicates by providing specific instructions and asking for feedback Supervises the scene of the action Delegates authority to others Understands and accepts the need to be flexible, modify plans Approves Incident Action Plan and evaluates its effectiveness Only position always staffed Ensuring safe work practices is the first duty of ICS leadership. Must balance response and safety (safety is THE priority). Initial IC holds post until they delegate the post to another qualified or more qualified person Overall responsibility of leadership of the IC Command staff General staff Teams, Group, Division, Branch, Demonstrates command within your scope of authority of assigned resources, Step back from tactical role to assume leadership, frame shift Integrity Team building Motivate responders Demonstrate initiative by making timely, sound decisions Communication, give specific instructions and asking for feedback Supervises the scene of the action Approves the Incident Action Plan and evaluates the effectiveness of the plan and organizational structure to meet the needs of the incident Slide courtesy of FEMA

Delegation of Authority
An Incident Commander's scope of authority is derived: From existing responsibilities or agreements Through a delegation of authority from the agency administrator or elected official in writing or verbally Grants authority to carry out specific functions and provides overall objectives / guidance Allows the Incident Commander to assume command. Does NOT relieve the granting authority of the ultimate responsibility for the incident. Delegation of authority comes from the governing board of your agency Incident Commander Hospital CEO Facilities have an institution-wide written chain of command procedure in their governance documents from Existing responsibilities or agreement, everyday operations Through a delegation of authority from the agency administrator or elected official The Emergency Preparedness Plan Delegation of authority grants authority to carry out specific functions and provides overall objectives/guidance Allows the Incident Commander to assume command Does not relieve the granting authority of the ultimate responsibility for the incident These documents approving delegation of authority have been approved by the governing board of the agency Slide courtesy of FEMA

Transfer of Command-Review
The process of moving the responsibility for incident command from one Incident Commander to another Occurs when More qualified person / team arrives End of operational period / extended incident handoff Always includes transfer of command briefing Current situation Response needs Available resources All personnel will be informed of the effective time and date of the transfer of command Transfer of Command is a feature of the Incident Management System that allows an orderly moving of responsibility from one incident commander to another. It must include a transfer of command briefing which may be oral or written or a combination of both including Current situation Response needs Available resources Occurs when A more qualified person/team arrives Incident situation changes over time, resulting in a legal requirement to change command There is a normal turnover of personnel on extended incidents The incident is concluded and responsibility is transferred to the home agency All personnel will be informed of the effective time and date of the transfer of command

Public Information Officer (PIO)
Advises Incident Commander on information dissemination and media relations. IC approves information releases by the PIO to external stakeholders Incident Commander Obtains information from and provides information to Planning Section for internal stakeholders. Planning Section Chief Public Information Officer Releases information to internal and external stakeholders (includes media). Extremely important to have timely, accurate information. May work from/with a community Joint Information Center (JIC). Joint Information Center (JIC) is where agencies come together to create correct, clear, consistent messages for the public and for each other. Obtains information from and provides information to community and media. Community and Media Slide courtesy of FEMA

Operations Section Chief
Safety Officer Advises Incident Commander on issues regarding incident safety. Incident Commander Works with Operations to ensure safety of field personnel. Operations Section Chief Safety Officer Safety Officer advises the IC on issues regarding incident safety This is the only person besides IC with ability to halt any operation due to safety concerns. EVERY event of significant size has a safety officer – they may look at weather, traffic, personal protective equipment, other issues related to worker and site safety. Ensures safety of all incident personnel. Incident Personnel Slide courtesy of FEMA

Agency Representative
Liaison Officer Assists Incident Commander by serving as point of contact for agency representatives who are helping to support the operation (but are not directly under the ICS). Incident Commander Liaison Officer Provides briefings to and answers questions from supporting agencies. Agency Representative Liaison Officer keeps partner agencies informed about the actions being taken. Information officer provides public and internal information about the event as approved by the IC The Liaison Officer (LO) is the primary contact between facility and supporting organizations (e.g.: Red Cross, public health) that are not directly involved in the operation. There may be many such organizations in a large event. A simple example is the Salvation Army and Red Cross at a house fire – Salvation Army provides food and support to the firefighters, while the Red Cross gives support to the families in our area IC may handle if few agencies, but in large events the LO is a full-time position. Slide courtesy of FEMA

Operations Section Chief
Expanding Incidents Divisions Groups Units Branches Single Resources Sections Incident Commander Operations Section Chief Command Add to the supervisory layers as the incident expands The ability to expand the sections as an incident expands is a critical feature of IMS. The Operations Section may need to add Branches If the incident expands further, the Operation Section may divide the Branches into Divisions or Groups For even larger incidents, the Groups may be divided into Units or Single Resources Slide courtesy of FEMA

General Staff General Staff in the ICS organizational structure are appointed as the incident complexity expands Incident Commander Public Information Officer Command Staff General staff is the term applied to the section chiefs as the incident complexity expands Operations Section Staff develop and implement strategy and tactics to carry out the incident objectives Planning Section Staff gather, analyzes and disseminate information and intelligence and Logistics Section Staff provide resources and services required to support the incident activities compiles the Incident Action Plan Finance/Administration Staff is responsible for financial and cost analysis of the incident We will talk about the responsibilities of these sections Liaison Officer Safety Officer General Staff Operations Section Planning Section Logistics Section Finance/Admin Section Slide courtesy of FEMA

Incident Command System Span of Control
Relates to the supervisory structure of the organization and pertains to the number of individuals or resources one incident supervisor can effectively manage 1-5 is the recommended ratio Organizing resources into Sections, Branches, Groups, Divisions, Units or Teams when the supervisory ratio will exceed 7 or demobilizing when the supervisory ratio falls below 3. The modular/flexible nature of the ICS allows for effective, efficient management Organizing resources into Sections, Branches, Groups, Divisions, Units or Teams when the supervisory ratio will exceed 7 Reorganizing or demobilizing Sections, Branches, Groups, Divisions, Units or Teams when the supervisory ratio falls below 3 1-5 is the recommended ration of supervisor to subordinates Expanding incidents will require supervisory concerns. How many people can you safely and efficiently manage is determined by this feature The ICS Span of Control feature is that expanding incidents brings with it increasing supervisor concerns. This principle pertains to the number of individuals or resources that one can manage effectively. It is key to effective and efficient management Span of Control is influenced by the Type of incident, Nature of the tasks, Hazard and safety factor Distance between personnel and resource The situation will dictate the number of individuals reporting to one person. If it is business as usual there could be individuals reporting to one person. However, in an event it could be as few one individual to assure safety, accountability and efficiency when life safety issues are involved, unusual situations, and unfamiliar staff/roles. It is best to aim for 5 persons under you – too few and you probably don’t need another division, too many and you can’t manage safely or effectively. Slide courtesy of FEMA

Maintaining Span of Control
The following supervisory levels can be added to help manage span of control: by organizing resources into Divisions, Groups, Branches or Sections Divide an incident geographically. Example east and west wing of hospital Divisions Examples Divisions could be the east or west wing of the hospital or 6th floor Groups could be the Decontamination group, Patient Care Group Branches could be the Medical Care branch in charge of employee health issues during the event. Span of control is influenced by: The type and complexity of incident or event The nature of the response or task, communications, distance, weather Training or experience of personnel Safety risks More dangerous and less familiar tasks call for smaller spans of control! Groups Describe functional areas of operation. Example, decontamination team Used when the number of Divisions or Groups exceeds the span of control. Can be either geographical or functional. Branches Slide courtesy of FEMA

Basic ICS Structure Organization
INCIDENT COMMANDER LIAISON OFFICER SAFETY OFFICER INFORMATION OFFICER We will now talk about the structure of the Operations Section and responsibilities of this section The Operations Section is responsible Conduct of tactical operations Formulation of tactical objectives and objective and organization Direction of tactical resources Presents the Incident Action Plan at the Operations Briefing Controls the staging area The Operations Section can be broken down into divisions, groups and branches depending on the needs of the incident OPERATIONS SECTION FINANCE SECTION PLANNING SECTION LOGISTICS SECTION Responsible for determining the appropriate tactics for an incident, conduct of tactical operations, formulation of tactical objectives & organization, & direction of tactical resources Slide courtesy of FEMA

Operations Section: Divisions
Divided geographically Labeled using alphabet characters (A, B, C, etc.). Managed by a Supervisor Division B Division A Di Divisions are divided geographically based on the needs of the incident One example would be divide up areas of the hospital into different divisions with a supervisor for each Labeled using alphabetical characters A,B,C Managed buy a Supervisor

Operations Section: Groups
Established based on the needs of an incident. Labeled according to the job that they are assigned. Work wherever their assigned task is needed and are not limited geographically. Groups are established based on the needs of an incident, such as decontamination groups and patient care group Labeled according to the job that they are assigned Managed by a supervisor Work wherever their assigned task is needed, no geographical limits Operations Section Decontamination Group Patient Care Group Slide courtesy of FEMA

Operations Section: 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. Branch Director This is an example for how communities break up operations into branches during an incident We will highlight some of those most likely to be used for Hospital Incident Command Operations Section Medical Care Branch Infrastructure Branch Security Branch Business Continuity Branch Slide courtesy of FEMA

Staging Manager is a new area for Hospital Incident Command
Operations Function Responsible for deploying resources May have several staging areas Medications Staff (Labor pool) Transportation Resources within the Staging Areas are available and ready for assignment (rest and repair areas are NOT located at staging) This is an added area for hospitals for managing people and stuff in Hospital Incident Command Located in a central location area (Staging Area) large enough to allow for the collection of personnel, vehicles, equipment/supplies and medications The Staging Manager will be responsible for deploying available assets in the Staging Area to areas that have requested a particular resource. Resources within the Staging Areas are available and ready for assignment (rest and repair areas are NOT located at staging) Works closely with Logistics Section to learn what is needed and to ensure that that the items are available

Branches that are essential for maintaining hospital operations
Medical Care Branch Responsible for the provision of medical care of the incident victims and patients already in the hospital Infrastructure Branch Facilitates the acquisition and access to essential recovery resources Security Branch Responsible for security for facility and staff, liaison with local agencies Business Continuity Branch Medical Care Branch Responsible for the provision of medical care of the incident victims and patients already in the hospital examples The Medical Care Branch Director will work closely with the Staging Manager to ensure needed medical personnel, equipment, medication and supplies are available and delivered to needed areas Infrastructure Branch Facilitates the acquisition and access to essential recovery resources Security Branch Responsible for security for facility and staff, liaison with local agencies Business Continuity Branch

Operations Section: Specialized individual or team of individuals needed for the incident
Task forces – mixed resources, common mission ( task force, search and rescue task force) Strike Teams – same resource (Code Blue,IV Team, water-mopping and mass immunization strike team) Single Resources – individuals or team of individuals Occasionally you may have a need for additional personnel resources which fit into the Operations Structure and can be deployed as Task Forces Are a combination of mixed resources which operates under the direct supervision of a Task Force Leader, thus lessening the span of control of the Supervisor Example, decontamination team Strike Team Is a combination of the same kind and type of resource that operates under the direct supervision of a Strike Team Leader to lessen the span of control of the Supervisor Example, mass vaccine clinic Single Resources An individual or crew of individuals with an identified supervisor

Basic ICS Structure – Modular Organization
INCIDENT COMMANDER LIAISON OFFICER SAFETY OFFICER INFORMATION OFFICER Planning Section gathers, analyzes, and disseminates information and intelligence OPERATIONS SECTION PLANNING SECTION FINANCE SECTION LOGISTICS SECTION Slide courtesy of FEMA

Planning Section Prepares & documents the Incident Action Plan, collects & evaluates information, maintains resource status, & maintains documentation for incident record The Planning Section, prepares & documents the Incident Action Plan, collects & evaluates information, maintains resource status, & maintains documentation for incident records The Planning Section facilitates the Operations Briefing Units Resource Situation Documentation Demobilization We will go on to discuss responsibilities of these units Slide courtesy of FEMA

Planning Section: Resources Unit
Conducts all check-in activities and maintains the status of all incident resources. Plays major role in preparing the written Incident Action Plan and maintaining planning cycle. Planning Section Resources Unit Demobilization Unit Situation Unit Resource Unit Conducts all check-in activities for resources, labor, equipment Plays a significant role in preparing the written Incident Action Plan which we will talk about later Documentation Unit Slide courtesy of FEMA

Planning Section: Situation Unit
Collects and analyzes information on the current situation. Prepares situation displays and situation summaries. Develops maps and projections. Patient and bed tracking functions Planning Section Planning Section Resources Unit Demobilization Unit Situation Unit Documentation Unit Situation Gathers information on current situation Prepares displays and summaries Develops maps and projections When planning it is important to talk with the individuals involved For example, check with the head nurse on night shift…will this plan work? Slide courtesy of FEMA

Planning Section: Documentation Unit
Provides duplication services, including the written Incident Action Plan. Maintains and archives all incident-related documentation. Planning Section Planning Section Resources Unit Demobilization Unit Situation Unit Documentation Unit Maintains and archives all incident-related documentation Provides duplication services, including the written Incident Action Plan We will talk about ICS forms later in the presentation Slide courtesy of FEMA

Planning Section: Demobilization Unit
Assists in ensuring that resources are released from the incident in an orderly, safe, and cost-effective manner. Resources Unit Demobilization Unit Situation Unit Documentation Unit Demobilization Unit assists in ensuring that resources are released from the incident in a safe, orderly, cost-effective manner. Slide courtesy of FEMA

Planning Section: Technical Specialists
Provide special expertise useful in incident management and response. May be assigned to work in the Planning Section or in other Sections. Advise the Incident Commander and/or assigned Section on issues related to emergency response in their area of expertise May be assigned as technical advisor in the HCC May be assigned to advise and oversee specific hospital operations Need to bring Technical Specialists in Command Center when you need them to assist with incident management and response Examples of specialists that may be called in for expertise Biological/Infectious disease Chemical Radiological Clinic Administration Hospital Administration Legal affairs Risk management Medical Staff Pediatric Care Medical Ethicist Other to be developed as needed by the hospital

INCIDENT COMMANDER LIAISON OFFICER SAFETY OFFICER INFORMATION OFFICER Provides resources and services required to support incident activities Logistics coordinates the support requirements necessary for the hospital to respond effectively to the demands associated with a disaster OPERATIONS SECTION PLANNING SECTION FINANCE SECTION LOGISTICS SECTION Slide courtesy of FEMA

Logistics Section - NIMS
Responsible for: Meeting the operational objectives Communications Medical support to incident personnel Food for incident personnel Supplies Facilities Ground support, Transportation Service Branch Support Branch Commun. Unit Supply Unit Medical Unit Facilities Unit 2 Branches Service Branch is responsible for supporting communication, resources needs and food services for staff Support Branch is responsible for coordinating resources for supplies, facilities and ground units Those in red are NIMS and not generally used within hospitals. Medical Unit – Medical related procedures for personnel responding to personnel assigned to an incident, not the provision of medical care for the public Ground support is support for out-of-service vehicles (gas, repair, etc) and transportation plan. Food Unit Ground Unit Slide courtesy of FEMA

Logistics Section HICS Logistics Section Chief Support Branch Director
IT/IS Unit Leader Staff Food & Water Unit Leader Communications Unit Leader Family Care Unit Supply Unit Employee Health & Well-Being Unit Facilities Unit Transportation Labor Pool & Credentialing Unit Logistics Section HICS Service Branch Service Branch Director Communications Unit Supporting communications Information Technology/Information Systems Ensures adequate communication resources over the incident Food and Water Unit Supplies the food and potable water for all incident facilities and personnel and obtains the necessary equipment and supplies to operate food facilities Support Branch Director Employee Health and Well-being Unit Physical, behavioral/mental Supply Unit Acquiring needed supplies Transportation Unit Coordinating internal and external transportation Family Care Unit Meeting employee family needs Facilities Unit Supporting infrastructure operations Labor Pool and Credentialing Unit Acquiring and credentialing additional personnel Slide courtesy of FEMA

IMS Feature: Resource Management
Categories Tactical Resources Personnel and major equipment used in the operation Support All other resources required to support the incident e.g., communications, food, other equipment, or supplies Resource Management includes processes for Categorizing resources Ordering resources Dispatching resources Tracking resources Recovering resources Reimburse for resources used Categories Tactical Personnel Major equipment Support, all other resources required to support the incident Food Communications Other equipment or supplies Mobilize only what you need / anticipate DON’T mobilize what you don’t need (e.g.: don’t’ cancel surgeries unless it’s clear that you need to…) Photographer: Ed Edahl Photo courtesy of FEMA

Tactical Resources Classifications
Assigned: Currently working on an assignment under the direction of a supervisor Available: Ready for immediate assignment and has been issued all required equipment Out of Service: Not available or ready to be assigned Incident Command System classifies resources into three categories Assigned Currently being in use under direction of a supervisor Available Ready for immediate assignment Out of Service Not available or ready to be assigned (maintenance issues, rest periods) Slide courtesy of FEMA

INCIDENT COMMANDER LIAISON OFFICER SAFETY OFFICER INFORMATION OFFICER Finance Section OPERATIONS SECTION PLANNING SECTION FINANCE SECTION LOGISTICS SECTION Slide courtesy of FEMA

Finance/Administration Section
Responsibilities include Timekeeping Cost analysis / cost data Handling claims related to property damage or fatalities Finance/Admin Section Time Unit Compensation/ Claims Unit Procurement Unit Cost Unit Finance Section is responsible for the management and direction of administrative matters pertaining to compensation / claims related to the INCIDENT! Finance Section will need forms to log extra help and to order equipment and supplies Finance Section is responsible for handling claims related to property damage, injuries or fatalities Photos courtesy of FEMA

Incident Complexity Analysis
Safety issues Impacts to critical operating systems Potential need to evacuate Potential need to relocate services Impact on essential resources and suppliers (e.g.: water supply) Impact on organization’s reputation Determine the objectives necessary to manage an incident (Incident Action Planning) Analyzing incidents will allow sound decisions to be made regarding Safety issues Impact to critical operating systems Potential need to evacuate Potential need to relocate services Impact on essential resources and suppliers (e.g. water supply, vaccines Steps to take if due to criminal action Impact on an organization’s reputation Determine what objectives are needed to manage an incident Photos courtesy of FEMA

IMS Feature: Incident Action Planning (IAP)
Reflects the overall strategy for managing an incident within a prescribed timeframe – the operational period (e.g.: 7am-7pm) IAP is primary source of objectives for action IAP often includes list of resources and assignments IAP may initially be verbal, but should become written soon in the process Monitors response to adjust for next period Documents results The Incident Action Planning specifies general objectives that reflect the overall strategy for managing an incident Initial step – what is your / institution role, responsibility, capability and policy regarding your actions? Includes strategy, tactical actions and supporting information for management of the incident Covers a specified timeframe called an operational period The Incident Action Plan may have a number of supportive “action plans” and should be qualified as such for example: Information Medical plan Water purification plan Traffic plan Safety plan Communication plan Maps

Managing by Objectives Incident Action Plan (IAP)
There is only one Incident Action Plan at an incident which identifies WHAT must be done? WHO is responsible? How information will be COMMUNICATED? What if a responder is INJURED? Overall Priorities Life Saving Incident stabilization Property Preservation Establish Incident Action Plan objectives, strategies, tactics Conduct a situation assessment WHAT must be done? WHO is responsible? How information will be COMMUNICATED? What if a responder is INJURED Overall Priorities Life Saving Incident stabilization Property Preservation Type of incident, magnitude, duration What ongoing safety issues are there Establish Incident Action Plan objectives, strategies, tactics Resources requested Initial step – what is your / institution role, responsibility, capability and policy regarding your actions? THEN look at situation Objectives are 10,000 foot (ensure life safety), Strategies are 1000 foot (evacuate the west wing), Tactics are ground level (Inpatient division supervisor will assign one nurse per patient to evacuate). MUST follow up as situation changes – how effective are the tactics employed, are the strategies shifting, etc.

IAP Establishes Objectives, Strategies, and Tactics
State what will be accomplished (agency exec and IC) Incident Objectives Establish the general plan or direction for accomplishing the incident objectives (IC) Strategies Within his or her scope of authority, the Incident Commander establishes Incident Objectives What will be accomplished Level 10,000 examples, secure the hospital Measurable Attainable within operational period Then determines strategies and resources within the IC structure Strategies Establish the general plan or direction for accomplishing the incident objectives (IC) Level 1,000 examples, control entrances and exits Tactics (Operations Sections) Specify how the strategies will be executed. Ground level examples, activate electronic locking systems MUST follow up as situation changes – how effective are the tactics employed, are the strategies shifting, etc. Tactics Specify how the strategies will be executed. (Operations) Photos courtesy of FEMA

Operational Times Initial response phase Extended response phase
Operational periods set by IC usual breakdown Immediate 0-2 hours Intermediate 2-12 Extended over 12 hours Initiate planning cycle Extended Response Phase Incident requires additional operational period (incident duration>8-12 hour) Determined by Situation assessment Incident action planning Resource management Operational periods is the period of time for execution of a set of operation actions as specified in the IAP Operational times can be of various lengths, although usually not over 24 hours Operational times are relative…it all depends… Bus accident incident relatively short term Pandemic flu incident, ongoing Incidents will require different operational periods Extended response phase is an incident requiring additional operational periods Based on incident complexity

Incident Action Planning
Forms to include in the IAP HICS 201: Incident Briefing (may serve as initial IAP) HICS 202: Incident Objectives HICS 203: Organization Assignment List HICS 204: Branch Assignment List HICS 205: Incident Communications Log HICS 206: Staff Medical Plan HICS 261: Incident Safety Analysis Twenty specific forms are available for use as part of HICS Important questions to ask regarding forms What function does the form serve? Who prepares it? Who receives it? Forms 201 and 202 are the forms generally used in IAP 201 Incident Briefing Form which may be used as the initial IAP 202 Incident Objective Form Other Forms are used to collect data regarding Details about the actual incident as they are learned Organizational assignments Critical problems encountered and incident command actions taken Patient care information Patient location Resources on hand and requests for supplementation Personnel time and accountability Internal and external communications Facility status Communications Incident safety Staff Medical Plan Once assignments are made, job action sheets will be given which will indicate the forms needed by that position

HICS 201 Form (Incident Briefing)
1. Incident Name, 2. Date of Briefing 3. Time of Briefing 4. Event History 5. Current Actions 6. Summary 7. Current Organization 8. Notes (Accomplishments, Issues, Directives) 9. Name of the individual who prepared the document 10. Facility Name HICS 201 is filled out to document initial response information & actions taken at startup. It is completed prior to briefing in the current operational period. HICS 201 Form includes Incident Name, Date of Briefing Time of Briefing Event History Current Actions Summary Current Organization Notes (e.g., Accomplishments, Issues, Warnings/Directives) Name of the individual who prepared the document Facility Name 1. Incident Name, 2. Date of Briefing 3. Time of Briefing 4. Event History 5. Current Actions 6. Summary 7. Current Organization 8. Notes (Accomplishments, Issues, Directives) 8. Name of the individual who prepared the document 9. Facility Name

HICS 202 Form (Incident Objectives)
1. Incident name 2. Date prepared 3. Time prepared 4. Operational period ( date & time) 5. General command & control objectives for the incident (including alternatives) 6. Weather/environmental implications during the period (forecast, wind speed/direction, daylight) 7. General safety/staff messages to be given 8. Attachments (ex. medical plan, facility system status) 9. Name of the individual who prepared the document 10. Approval of the Incident Commander 11. Facility name HICS 202 Form is completed prior to briefing in the current operational period. The form serves as a roadmap to incident management. The form is used during the initial operational period, during briefings and debriefings. HICS 202 Form includes The Incident Name Date Prepared Time Prepared Operational Period (including Date & Time), General Command & Control Objectives for the Incident (including Alternatives), Weather/Environmental Implications during the Period (Forecast, Wind Speed/Direction, Daylight), General Safety/Staff Messages to be Given, Attachments Name of the individual who prepared the document Approval of the Incident Commander, & the Facility Name.

Mobilization: Checking In/ Incident Briefing
Officially logs you in at the incident To ensure personal accountability Track resources Receive assignment Know your responsibilities, (Job Action Sheets) Identify location for work, rest, staging areas Shift duration Procedure for getting staff/stuff Safety procedures and Personal Protective Equipment (if relevant) Receive an incident briefing from your supervisor Checking In is the Mobilization feature of ICS Officially logs you in at the incident To ensure personal accountability Track resources Receive assignment Know your responsibilities, (Job Action Sheets) Identify location for work, rest, staging areas Shift duration Procedure for getting staff/stuff Safety procedures and Personal Protective Equipment (if relevant) Receive the Incident Briefing from supervisor Chain of Command Feature assures that each individual will be assigned to only one supervisor

Job Action Sheets (JAS)
1. Title 2. Purpose 3. To whom they report 4. Critical action considerations 5. Forms required by the job 6. Broken into operational periods Immediate 0-2 hours Intermediate, 2-12 hours Extended, >12h JAS “prompts” the team member to take needed actions related to their roles and responsibilities Job Action Sheets are received when assignments are given Job Action Sheets is an incident management tool designed to familiarize the user with critical aspects of the command position he or she will be assuming. This sheets include Radio identification title (common terminology) Purpose of job To whom they report Critical action considerations Documentation area Graphically depicts the position within the Incident Management Team Highlights reporting relationships Information regarding forms needed for this job Job action sheets prompt the team member to take needed actions related to their roles and responsibilities JAS are primarily used for the first operational period

Activation of Organizational Elements
ICS organizational structure should include only the functions and positions needed to achieve the incident objectives Organizational elements may be activated without activating the Section Chief. In this case, the unit reports to the IC directly Deputy positions can be found for the Incident Commander, Branch and Section Chiefs Incident Commander Safety Officer Organizational elements may be activated without activating the Section Chief In this case, the unit reports to the IC directly For example, IC appoints decontamination unit for small number of contaminated casualties… In this example the situation unit of the Planning Section is activated by the IC without a Section Chief. In this example the Situation Unit Leader would report directly to the Incident Commander Deputy positions can be used for Incident Commander, Branch and Section postiions Operations Section Situation Unit Rescue Group Medical Group Photos courtesy of FEMA

Photos courtesy of FEMA
Things To Avoid Do not combine ICS positions to save on staffing. Individuals may supervise multiple units, but the positions should remain distinct. Bob Bob Supply and Facilities Unit Leader Supply Unit Leader Facilities Unit Leader It is important that ICS positions are not combined to save on staffing. Individuals may supervise multiple units but the positions should remain distinct. Do not use nonstandard titles or hybrid positions. These titles may be unrecognizable to assisting or cooperating personnel. Photos courtesy of FEMA

United States Coast Guard
Planning Meeting Develop strategies & tactics to Accomplish objectives Incident is recognized Notifications, assessment, Immediate needs are addressed Incident Manager Sets overall incident objectives & priorities Action Plan preparation & approval Management Meeting Evaluates & revises incident objectives On-going situation assessment & information processing Operations Briefing Briefs the operational leaders on the Action Plan The intention of this presentation is to explain the critical components of the Hospital Incident Command System needed for incident management from the early stages onward. This diagram explains the incident lifecycle which we have covered through this presentation Recognition of incident Notification Assessment Shift from proactive to reactive Establishment of ICP/objectives/priorities Note the planning meeting is based on the IC’s objectives and priorities. During the Planning meeting an Incident Action Plan is developed to accomplish the objectives The Incident Action Plan is shared in the Operations briefing, Progress is assessed by using measures of effectiveness The Command and General staff gather for the management meeting to evaluate, and revise the incident objectives IC then revises objective/priorities and start over… Assess progress using measures of effectiveness Implement Action Plan United States Coast Guard

ICS Communication System
Improves communication – internally and externally Standardizes terminology Allows accountability Two Types of communication Formal follow lines of authority when Receiving and giving work assignments Requesting support or additional resources Reporting progress on assigned tasks Informal communication does not follow lines of authority Is used to exchange incident or event information only Allows for documentation on HICS Forms Communication within the Incident Command Occurs at Formal level communication allows the Incident Commander and other supervisors to manage the incident or event more efficiently due to a decrease in time spend directing and communicating with people outside of their direct authority Receiving and giving work assignments Requesting support or additional resources Reporting progress of assigned tasks Informal communication is used to exchange incident information only. It is not used for Formal requests for additional resources Task, work assignments allows the free flow of critical information during an incident Informal communication lines allow for the free flow of critical information during an incident Document your communications! If you acknowledge a message – LOG it on HICS Forms

Chain of Command (Single, Unity)
Incident Commander Orderly Line of Authority Single Command Public Information Officer Command Staff Liaison Officer Safety Officer General Staff Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief Chain of command assures an orderly line of authority, lower levels subordinate to higher Every individual is responsible to ONE supervisor during an incident – they should know who this person is and how to contact them Chain of Command feature helps to clarify reporting relationships to eliminate confusion caused by multiple, perhaps conflicting directives. Incident managers at all levels must be able to control the actions of all personnel under their supervision. Chain of command is a series of command, control, executive, or management positions in hierarchical order of authority. For example, a unit leader does not report directly to IC. Unity of command means that every individual has a designated supervisor to whom they report at the scene of the incident. Not to be confused with Unified Command which will be addressed on next slide So hazmat branch director does NOT answer to IC directly. Everyone has ONE supervisor they report to, avoiding confusion… HAZMAT Branch Director Medical Care Branch Director Service Branch Director Support Branch Director Unity of command Means that each employee answers to ONE supervisor Photos courtesy of FEMA

Single versus Unified Command
Single command One organization and single IC has complete responsibility for incident (hospital receives victims from train crash) Unified command Multiple agencies / organizations share responsibility Collective / collaborative approach Single set of objectives for multiple agencies Improved information flow and coordination Agencies understand joint priorities and restrictions Single IAP Early in an incident, the hospital must be integrated into the community response including the overall incident command structure Single command, one organization and single IC has complete responsibility for incident (hospital receives victims from train crash) Unified command is used when more than one responding agency is present or the situation crosses political jurisdictions Senior leadership from identified agencies are co-located and make decisions together as they Analyze available information Establish common set of objectives Strategize for a single Incident Action Plan Example, (hospital is on fire and evacuating – hospital, EMS, fire form under unified command) Agency Agency Agency 3 Photos courtesy of FEMA

Information and Intelligence Within ICS
Establishes a process for gathering, sharing, and managing incident related information and intelligence Assures that internal information is safeguarded but also ensures availability to those who need it to perform their jobs effectively and safely. Often handled within Planning, Situation Unit However, in some situations may require: As a branch within Operations Within the Command Staff As a separate General Staff Section Information and intelligence within ICS establishes a process for gathering, sharing, and managing incident related information and intelligence Assures that internal information is safeguarded but also ensures availability to those who need it to perform their jobs effectively and safely. Often handled within Planning, Situation Unit However, in some situations may require: As a branch within Operations Within the Command Staff As a separate General Staff Section Depends on the type and sensitivity of the intelligence being gathered – usually this is a situation unit function however.

Types of Briefings/Meetings
Staff-Level Briefings: Delivered to resources assigned to non-operational and support tasks at the Incident Command Post or Base. Field-Level Briefings: Delivered to individual resources or crews assigned to operational tasks and/or work at or near the incident site. Staff level briefings Delivered to resources assigned to non-operational and support tasks at the Incident Command Post They typically occur at the beginning of an assignment and as necessary during an assignment Clarify tasks and scope of the work Define workspace sources of work supplies and work schedule Field level briefings Delivered to individual resources or crew assigned to operational tasks and/or work at or near the incident site Will be delivered to individuals, full crews or multiple crews such as strike teams or task forces (e.g. IV Teams, mass immunization teams Section-level briefings Delivered to an entire Section (for example, the operational period briefing or Planning, Logistics of Finance Section briefings.) The supervisor will share incident wide direction and impact on the section as how the section can support the IC objectives Section-Level Briefings: Delivered to an entire Section (e.g., the operational period briefing). Photos courtesy of FEMA

ICS: Briefings/Meetings
Essential to effective supervision and incident management Clearly stated objectives Short concise meetings, no long discussions or complex decision making Allow manager or supervisor to pass along specific information and expectations for the upcoming work period and to field questions related to that information Task Purpose Why it is to be done? End State How it should look when done? Briefings an essential element to good supervision and management of an incident These short concise meetings, no long discussions or complex decision making Allows manager or supervisor to pass along vital information that will be useful for staff for the completion of jobs for the upcoming work period Offer an opportunity for staff to ask questions, seek clarification from supervisor Are held at all levels of the modular organization The briefings will be concise and specific related to the IAP objectives What is to be done? The task. Why is it to be done? The purpose. How it should look when it is done? What is the end state What is to be done? Photos courtesy of FEMA

Operational Period Briefing (Shift briefing)
Conducted at the beginning of each operational period Facilitated by the Planning Section Chief Operations Briefing is held to introduce IAP to Branch Directors and Division/Group Supervisors After the Operational Briefing, the Incident Action Plan is implemented May be referred to as the shift briefing Is conducted at the beginning of each operational period The Planning Section Chief reviews the agenda and facilitates the briefing The IC presents the IAP for the shift to personnel with supervisory roles

Schedule for Operations Briefing
Planning section chief reviews agenda and facilitates ▼ IC presents objectives (sometimes defers to Planning Chief to present) Off-going Operations Section Chief – provides current assessment and accomplishments during last ops period Oncoming Operations Section Chief – covers work assignments and staffing Technical Specialist -Safety Officer – Special Operations –present updates May have specific Unit Leaders present information Final IC comments Planning Section Chief announces next briefing time/location, adjourn OPERATIONS BRIEFING Planning section chief reviews agenda and facilitates ▼ IC presents objectives (sometimes defers to Planning Chief to present) Off-going Operations Section Chief – provides current assessment and accomplishments during last ops period Oncoming Operations Section Chief – covers work assignments and staffing Technical Specialist -Safety Officer – Special Operations –present updates May have specific Unit Leaders present information Final IC comments Planning Section Chief announces next briefing time/location, adjourn

IMS Feature: Pre-designated Key Facilities and Locations
Incident Command Post – where the Incident Commander oversees the incident Emergency Operations Center – multi-agency center supporting operations Staging area / Labor pool – where available stuff or staff await assignment Hospital Emergency Plan should contain a map with symbols showing pre-designated facilities and locations Incident Command Post (ICP): Is the location from which the Incident Commander oversees incident operations at the site or facility? May change locations during the event. May be located in a vehicle, trailer, tent, or within a building. Should be positioned outside of the present and potential hazard zone but close enough to the incident to maintain command. An Emergency Operations Center (EOC) Is the physical location where an organization comes together during an emergency to coordinate response and recovery actions and resources. These centers may alternatively be called command centers, situation rooms, war rooms, crisis management centers, or other similar terms. This is where the coordination of information and resources takes place. The EOC is not an incident command post; rather, it is the operations center where coordination and management decisions are facilitated. Staging Areas: Temporary locations at an incident where available personnel and equipment are kept while waiting for tactical assignments. May be more than one staging area Close enough to the incident for a timely response, but far enough away to be out of the immediate impact zone. May be collocated with the ICP or other facilities S Photos courtesy of FEMA

IMS Feature: Pre-designated Key Facilities and Locations
H Helibase Location from which helicopter-centered air operations are conducted Helibases are generally used on a more long-term basis and include such services as fueling and maintenance Helispot Are more temporary locations at the incident, where helicopters can safely land and take off. Multiple Helispots may be used H-3 Helibase The location from which helicopter-centered air operations are conducted. Helibases are generally used on a more long-term basis and include such services as fueling and maintenance. Helispots Are more temporary locations at the incident, where helicopters can safely land and take off. Multiple Helispots may be used. Photos courtesy of FEMA

IMS Features Summary ◦ Pre-designated incident locations & facilities
Common Terminology Modular Organization Management by Objectives Reliance on an Incident Action Plan (IAP) Chain of command & unity of command Unified Command Manageable span of control ◦ Pre-designated incident locations & facilities ◦ Resource Management ◦ Information & Intelligence Management ◦ Integrated Communications ◦ Transfer of Command ◦ Accountability ◦ Mobilization Common terminology means that communications should be plain in English or clear text. It also means that you should not use radio codes, agency-specific codes, or jargon. Modular Organization means that the Incident Command System develops in a top-down modular fashion; is based on the size & complexity of the incident; & is based on the hazard environment created by the incident. Management by Objectives means that the objectives are communicated throughout the entire ICS organization throughout the incident planning process. Incident Action Plan specifies the incident objectives, states the activities to be completed, covers a specified timeframe, or may be oral or written. Chain of Command is an orderly line of authority within the ranks of the incident management organization. Unity of command means that every individual has a designated supervisor to whom they report at the scene of the incident. Unified command enables all responsible agencies to manage an incident together by establishing a common set of incident objectives & strategies; allows incident commanders to make joint decisions by establishing a single command structure; & maintains unity of command. Manageable span of control pertains to the number of individuals or resources that one supervisor can manage effectively during the incident. Pre-designated incident locations & facilities are established based on the requirements & complexity of the incident. They are built to accomplish a variety of purposes, such as decontamination, donated goods processing, mass care & evacuation. Resource Management includes processes for categorizing, ordering, dispatching, tracking & recovering resources so that they can be managed effectively. Information & Intelligence Management are critical to incident response. It’s a process for gathering, sharing & managing incident-related information & intelligence. Integrated Communications are facilitated through the development & use of a common communications plan, & the interoperability of communication equipment, procedures & systems. Transfer of command is the process of moving responsibility for incident command from one Incident Commander toi another. Accountability adheres to the principles of Check-In, Incident Action Plan, Unity of Command, Span of Control & Resource Tracking. Mobilization is the managing of resources to adjust to changing conditions. Action planning is a critical part of IMS and not often practiced by hospitals - it involves identifying objectives to be met, an action plan for achieving them, and the resources that will be needed anticipating the next operational period (the next day or shift, for example). Did not use “Modular” used in 100 but not test question in 700, its “flexible”

4 Phases of Comprehensive Incident Management (CEM) Activities for “all hazard” planning
Notification Mitigation (Prevention) Preparedness Response Recovery Examples Mitigation (including prevention) Prevention activities that reduce impact of hazard Example: build dikes to prevent flood Conduct public health surveillance, testing immunizations and quarantine for biological threats Preparedness Build response capacity/capability Example: buy dike plugs Response Gain control of an event Examples: plug dike when a hole appears, Emergency shelter, housing, food & water Search and rescue Evacuation Emergency medical services Recovery Return to pre-disaster state Examples: Repair/replacement of dike, damaged public facilities (bridges, schools, hospitals) Debris cleanup & removal Temporary housing In review, your hospital your hospital Emergency Management Program contains a number of critical elements that serve as the foundation for incident management Comprehensive Incident Management Activities (CEM) serve as the basic framework for the planning, training and exercises that hospital must undertake to be adequately prepared and compliant with pertinent regulations, standards and guidelines Prevention activities: reduce the impact of an event Preparedness activities: tools that assist with building a response capability. Examples are establishment of mutual aid agreements Response activities: assist with gaining control of an event. Emergency restoration of critical services Recovery activities: tassist with returning to pre-disaster state All hazard approach is the same general management for any incident no matter what the cause: biological, chemical, natural disaster, criminal, terrorist ICS-HC 200 Test question NIMS slide adaptation

ICS Tools Emergency Operations Plan
Hospital Policies and Procedures Manual ICS Forms Position Description and Job Action Sheets Other resource materials

Are you Ready? Are you now able to:
Explain how the modular organization expands and contracts? Given a scenario, recognize complicating factors? Use a planning cycle? Create an incident action plan?

MERET Acknowledges its Partners:
1. Healthcare System Preparedness Program Partners a. Minnesota Department of Health–Office of Emergency Preparedness b. MDH Metropolitan Hospital Compact c. Regional Hospital Resource Center Focus Group: • Michelle Allen, Northwest • Clyde Annala, Northeast • Jill Burmeister, South Central • Chuck Hartsfield, Central • Marla Kendig, Southeast • Emily Parsons, MDH-OEP • Justin Taves, West Central • Eric Weller, South Central 2. FEMA Independent Study Program

Elective Slides Volunteer groups that may be deployment during an incident The following 4 slides are included as an opportunity to discuss volunteer groups that may be deployed during an incident.

Categories of MN Emergency Readiness Volunteers…
MN Disaster Medical Assistance Team (FEMA) Minnesota Responds/Medical Reserve Corp. Community Emergency Response Teams (CERT) MN Disaster Medical Assistance Team (MN DMAT) Are teams of professional and paraprofessional medical personnel (supported by logistical and administrative staff) that can provide emergency medical care during a disaster or catastrophic events. Are designed to be a rapid –response group to supplement local medical care until other resources can be mobilized or until the situation is resolved A team consists of 35 physicians, nurses and other allied health care and support personnel. There are 29 fully deployable tames throughout the United States The MN-1 DMat is trained for federal disaster medical response but also for public health emergencies with the state and surrounding region Ready to go with 6-12 hours

Minnesota Responds Pre-registers, manages and mobilizes volunteers to help communities respond to all types of disasters Help communities cope up with medical and public health needs Register through Volunteers attend a program orientation or training Volunteers assigned according to training needs, profession, or skills Anyone who has interest in volunteering during a health emergency is encouraged to register* MN Responds recruits the following people to have their skills used in the event of health emergencies: • Healthcare professionals, such as physicians, nurses, pharmacists, dentists, nursing assistants, respiratory therapists, psychiatrists, veterinarians, etc. • Public health professionals • Behavioral health and social service professionals including psychologists, social workers, counselors, interpreters, and chaplains • Support staff such as clerical workers, data entry, greeters, traffic control, canteen workers, etc.

Medical Reserve Corps (MRC)
There are 13 MRC Units throughout Minnesota Apply through the Minnesota Responds website Or your local public health agency. Your name will be stored in both the MN Responds and MRC databases Many positions in Medical Reserve Corps do not require a license, training and experience more valuable If licensed, Medical Reserve Corps staff will verify status of license with appropriate licensing board Volunteers assist with public health initiatives community activities if there is no emergency Volunteers work in mass dispensing or vaccination clinics, serve as staff at local hospital or off-site care facility; and provide expert info. to local residents *Community activities include… • Volunteering during public health or hospital drills that test emergency response systems • Support Medical Reserve Corps program staff in areas of recruitment, training, program development, present information about MRC in the community, or receive advanced training to become a MRC team leader or liaison • Assist with key public health initiatives such as participation in community flu or vaccination clinics, or serving on task force or an advisory committee **Medical Reserve Corps needs… Physicians and physician assistants -Respiratory care specialists Nurses and nurse practitioners - Social workers Pharmacists - Mental Health professionals Dentists - Language interpreters Nursing and medical assistants - Chaplains Lab personnel - Medical data personnel Health educators - Other health profs and support staff Insert information regarding local MRC here

Community Emergency Response Team (CERT)
Trained civilians to assist with emergency needs following a disaster Training programs are offered within communities by first responders Concepts covered are Immediate needs following a disaster Mitigation/preparedness activities Life saving, decision-making skills,and rescuer safety Offer immediate services until professional resources arrive Community Emergency Response Teams (CERT) were implemented after 1985 in Los Angeles. The Whittier Narrows earthquake underscored the needs of training civilians to meet immediate needs of communities Training programs are offered in communities by first responders with established curriculums Concepts covered are How to meet the immediate needs of communities following a disaster What are mitigation/preparedness activities that can be undertaken Life saving, decision making skills, Rescuer skills What immediate services can be offered until professional resources arrive There are 28 CERT Teams in MN Insert local information here

If you are assigned outside your facility
Assure that you have a sponsoring organization, travel, and housing Authorization to leave, payroll, worker’s compensation issues Personal and technical items packed (copies of licenses, etc) Ensure that family knows where you will be and how you can be contacted Again, self-assigned personnel do NOT work well – wait for an invitation to the party! (and make sure they have your logistics covered…)

Incident Management for Healthcare

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