Incident Management for Healthcare Operations

Incident Management for Healthcare Operations
Based upon Emergency Management Institute ICS-200HC This course is designed to build on knowledge obtained in the 100 level basic course. It is intended for those within the healthcare facility who will be expected to assume an incident commander, command staff, or general staff (section chief) role during the ‘later’ phases of the event (i.e.: somebody who may temporarily have the IC role for up to the first 60 minutes of an event is NOT required to take this course – only ICS-100HC / Basic).

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. This Hospital Incident Command System (HICS) allows for standardized terminology, response concepts and procedures for interagency response efforts The objectives of this course are to Provide tools & techniques for persons who are likely to assume command roles during an incident to prepare them for their Incident Command System role Understand Emergency Management Program at your facility Understand additional ICS forms and tools that will be used Apply the Incident Management Process

Imagine the role you will play in your facility during this presentation
You have completed IS 100 for Health Care Facilities YOU…have Had an overview of what Hospital Incident Command is about Been called to fill a position in the ICS during this presentation What might you be asked to do in an emergency event within your facility?

Scenario 30 minutes ago, a tornado warning was issued for a projected touchdown in this community It is now 6:08 am, storm related injuries have been coming in from surrounding areas. One injured patient is in the OR Scattered power outages are being reported in the area Lights are flickering in the hospital There is a roar and the entire facility shakes momentarily Imagine your thoughts, feelings, & actions in this scenario 30 minutes ago, a warning was issued for a tornado projected to make a touchdown in this community It is now 6:08 am, storm related injuries have been coming in from surrounding areas. One injured patient is in the OR Scattered power outages are being reported in the area Lights are flickering in the hospital There is a roar and the entire facility shakes momentarily

How you would respond? □ Too busy - it’s 6:08 am and a shift change will happen in 60 minutes. Day shift can deal with this. □ Panic - realize that you don’t know anything about the hospital’s Emergency Operations Plan or where to find it. □ Reassign the most experienced ICU nurse to open the Command Center. □ Call the on call administrator for back up and begin an immediate plan of action How would you respond? What training has given you the information to act?

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

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 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: to assist 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

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! This slide from ICS100 reminds us of the movement from reactive to proactive phase 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

Slide courtesy of VA Emergency Management Training Curricula
Getting Organized… Nature Day of the Week What ? Where ? When ? Who’s Involved ? Where Is It Going ? Size Initially Location Time of Day Mobilization Checklist INCIDENT BRIEFING Date/time of start of incident Type of incident Services involved Current incident status Current resource status Current strategy/objectives Communications systems being used Special problems/issues Command Post Incident Action Planning Sizing up the situation is key to mobilizing the right resources For example, don’t want to cancel surgeries for a decontamination event, or for a trauma event involving only minor injuries Slide courtesy of VA Emergency Management Training Curricula

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) Event is due to criminal action Impact on organization’s reputation 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 Photos courtesy of FEMA

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

IMS Feature: Incident Action Plan (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 Plan is a plan that 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: Medical plan Water purification plan Traffic plan Safety plan Communication plan Maps

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 Tactics Specify how the strategies will be executed. (Operations) Slide 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.

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 JAS “prompts” the team member to take needed actions related to their roles and responsibilities Job Action Sheets are received when assignments are given Information includes: Job title Purpose To whom they report Critical action considerations Forms required by the 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 (reactive phase)

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 ICS 100 Review of Command and General Staff under the IC 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

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 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 response These documents approving delegation of authority have been approved by the governing board of the agency Photos courtesy of FEMA

Incident Commander Review
Provides overall leadership for incident response Only position ALWAYS staffed Delegates authority to others May appoint deputy if needed Initial IC holds post until they delegate the post to another qualified / more qualified person Approves IAP and all major resource requests Provides overall leadership for incident response There is ALWAYS an IC. There may not be anybody else assigned for some events but even this means that you who to get information to/from and who is in charge. The IC usually is NOT the agency executive – the agency executive delegates authority to the IC to run the incident (may occur some time into the incident), in the community this may be done in writing. Through the Incident Command System is able to delegate authority clearly to others. Deputy IC should be able to assume IC duties (i.e.: is NOT an ‘assistant’ or scribe function). The initial IC holds the post until they delegate the post to another qualified or more qualified person. Develops overall objectives Approves IAP and all major resource requests

Incident Commander Leadership Responsibilities
Ensures safe work practices Takes command Motivates responders Demonstrates initiative by taking action Communicates by providing specific instructions and asking for feedback Supervises the scene of the action Evaluates the effectiveness of the plan Understands and accepts the need to be flexible, modify plans Ensuring safe work practices is the first duty of ICS leadership. Must balance response and safety (safety is THE priority). Overall responsibility of leadership of the IC Command staff General staff Teams, Group, Division, Branch, Take command within your scope of authority of assigned resources, Step back from tactical role to assume leadership, frame shift Integrity Team building Motivate responders Watch out for their well being Keep them informed Demonstrate initiative by making timely, sound decisions Communication, give specific instructions and asking for feedback Supervises the scene of the action Evaluates the effectiveness of the plan and organizational structure to meet the needs of the incident Flexibility, understand and accept the need to modify plans or instructions according to the needs of the incident

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

Modular Organization The modular/flexible organization structure of the ICS allows standardization of positions and number of positions depending on the extent of the incident ICS organizational structure should include only the functions and positions needed to achieve the incident objectives ICS positions may not be combined in order to save on staffing or achieve a higher level of efficiency ICS recognizes that an Incident Commander is always necessary no matter what other additional positions are assigned ICS 200 Test question Slide courtesy of FEMA

Activation of Organizational Elements
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 positions Operations Section Situation Unit Rescue Group Medical Group Slide 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. Slide courtesy of FEMA

Liaison Officer, coordinates assisting or contributing agencies
Command Staff Review The Incident Commander may need to designate staff who can provide information, liaison, and safety services for the entire organization Public Information Officer Command Staff Incident Commander Liaison Officer Incident Commander Command Staff Incident Commander can delegate responsibilities as needed during an event. The Command Staff includes a Public Information Officer, Liaison Officer and Safety Officer. Public Information Officer, releases information to internal/external stakeholders. In large events there may be a Joint Information Center (JIC) that coordinates Interagency messages Develops public information plans Advises IC Rumor control Safety Officer, advises the IC regarding incident safety, worker and sites Liaison Officer, coordinates assisting or contributing agencies Assisting Agency – DIRECT responsibility for incident response (e.g.: hospital closest to incident) Cooperating Agency – Assistance other than direct operational or support functions (e.g.: hospital from 100 miles away sends staff to help) Representatives from assisting and cooperating agencies & organizations work with Liaison officer Deputies must be qualified to assume position they are serving not the same as assistant/scribe (ONLY for IC, Section chiefs, and Branch Directors) Assistant/Scribe – help with workload, communications, etc. Safety Officer Public Information Officer, releases information to internal/external stakeholders Safety Officer, advises the IC regarding incident safety, worker and sites Liaison Officer, coordinates assisting or contributing agencies Slide courtesy of FEMA

General Staff-Review 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 Responsible for tactical operations Presents the Incident Action Plan (IAP) Operations is often heavily burdened initially with both response and planning process tasks Planning Prepares and documents the Incident Action Plan Facilitates the Operations Briefing Situation and Resources units busy early, Documentation and Demobilization Units are busy later Logistics Provides resources and services required to support incident activities Finance Responsible for handling claims related to property damage, injuries, or fatalities Liaison Officer Safety Officer General Staff Operations Section Planning Section Logistics Section Finance/Admin Section Slide courtesy of FEMA

General Staff Review Operations Planning Logistics Finance
Responsible for determining the appropriate tactics for an incident Conducts tactical operations, develops the tactical objectives, and organizes & directs all tactical resources Presents the Incident Action Plan (IAP) Planning Prepares and documents the Incident Action Plan Facilitates the Operations Briefing Logistics Provides resources and services required to support incident activities Finance Responsible for handling claims related to property damage, injuries, or fatalities Operations Typically one of the first Sections to be assigned Responsible for determining the appropriate tactics for an incident Conducts tactical operations, develops the tactical objectives and organization and directs all tactical resources Has most direct incident resources Controls staging Direct input in preparing the Incident Action Plan Planning Prepares and documents the Incident Action Plan Facilitates the Operations Briefing Logistics Provides resources and services required to support incident activities Finance Responsible for handling claims related to property damage, injuries, or fatalities

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 an expanding structure. 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 a 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. Divisions and groups are at the same level (supervisor) – so one does NOT fall under the other Remember, once you get to groups, you have only two divisions (units and single resources) that can go under that, so If you exceed 5-7 units, you’re going to have to go to branches… Include only the functions and positions required to attain the objective 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 Include only the functions and positions required to attain the objectives!

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 examples 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 Review slide from ICS 100 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

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

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 Slide 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.

Briefings/Meetings Features of ICS
Essential to ICS for good supervision and incident management 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 Opportunity to field questions from subordinates related to that information 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

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). Slide courtesy of FEMA

How it should look when done?
Briefings Clearly stated objectives and the following elements: Task Purpose Why it is to be done? End State How it should look when done? 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? The end state What is to be done? Slide 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

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 was 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 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

Incident Management for Healthcare Operations

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