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gHospital

Incident Command System

Train-The-Trainer Course

National Disaster Medical System (NDMS)Conference

March 16-18, 2007

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Course Expectations

Why are you here today?

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gCourse Objectives

• Outline the historical development of HEICS and HICS

• Discuss NIMS Implementation Activities for hospitals

• Learn the principal concepts and features of HICS

• Understand the roles and relationships of the Incident Management Team

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gCourse Objectives (2)

• Understand the application and use of the HICS elements

• Conduct a facilitated, scenario-based exercise

• Discuss train-the-trainer strategies for implementing and teaching HICS

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gThis course is presented by:

The Center for HICS Education and Training

• The Center is a collaborative effort between the ER 1 Institute at Washington Hospital Center and Kaiser Permanente

• Our mission is to provide information, education and training on HICS

• The Center’s Advisory Board consists of National Workgroup and Ex-officio members from the HEICS 4 project

• The Center sponsors a webpage for additional info and updates on HICS utilization at www.hicscenter.org

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gCourse Faculty

Craig DeAtley, PA-CDirector – Institute for Public Health

Emergency Readiness, Washington Hospital Center

Ann Potter, RN, CEMChief, Disaster Preparedness Division

Office of Emergency Services and Homeland Security

Peter BrewsterEducation/Training Manager

Department of Veteran’s AffairsEmergency Management Strategic Healthcare Group

Craig Thorne, MD, MPHMedical Director, Employee Health & Safety

University of Maryland Medical Center

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gHousekeeping Notes

• All technology to “silent” or “vibrate” please• If you must take or make a call

– Wait for a break– Leave the room for calls

• We will have regular breaks during the course– Please stay within the announced break times

• Restroom location(s)• Emergency exits• There will be time for Q&A- save your questions to

the announced periods• Please consult with the instructors during breaks if

needed • Your evaluations are important to us! Complete the

evaluation form by the end of the day!

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gDay 1 Agenda

• NIMS Implementation Activities for Hospital and Healthcare Organizations

• Origins of HICS• Overview of HICS Components• The Hospital Incident Command System• Job Actions Sheets• Incident Planning & Response Guides• Forms• Discuss relationship of the hospital to its community

partners• Learn about adapting HICS to rural and small

facilities• Course Evaluation and Wrap Up

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gCourse Copyright

• The HICS course materials are proprietary and cannot be duplicated, reproduced or utilized without written permission of The Center

• No cameras or video taping or recording of this program are permitted

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Emergency Response

Is Not

Business as Usual !

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gWhat is the Hospital Goal?

• Preparedness– Develop effective Emergency Management and

Operations Plans

• Response– Ensure safety of patients, personnel and facility

– Triage, treat, transfer and disposition victims

– Ensure business continuity

• Recovery– Operational/Business Recovery

– Financial recovery

– Restoration of “normal” operations

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NIMS

Implementation Activities for Hospitals and

Healthcare Systems

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gNIMS Implementation Activities for Hospitals and Healthcare Systems

• Document September 12, 2006– Developed by NIC and DHHS– Outlines the 17 Implementation Activities for

hospitals– National Bioterrorism Hospital Preparedness

Program (HBHPP), administered through HRSA, outlines compliance for FY 2006 funding cycle

• Training: ICS 100 and 200 and IS 700

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gNIMS Implementation Activities for Hospitals and Healthcare Systems

• Implementation document outlines:– The element– Element’s association to NIMS– Implementation Guidance– Implementation Example– References

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gNIMS Implementation Activities for Hospitals and Healthcare Systems

• NIMS Implementation Activities have seven categories:– Organizational Adoption of NIMS– Command and Management– Preparedness Planning– Preparedness Training– Preparedness Exercises– Resource Management– Communication and Information Management

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gNIMS Implementation Elements

Organizational Adoption

• Element 1– Adoption of NIMS– Adopt NIMS throughout the organization– Implementation Guidance:

• Plan for full implementation• A “Phased In Approach”• Hospitals should develop a plan, strategy and timeline to

implement the elements– It can be implemented over time!!! Not immediate or all at once!

• NBHPP outlines implementation elements

– Example: All 17 elements are included in the hospital’s Emergency Management Program (EMP)

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gNIMS Implementation Elements

Command and Management

• Element 2 – Incident Command System– Manage all emergency incidents, exercises and

preplanned events in accordance with ICS– Must include

• Incident Action Planning (IAP)• Common communication plans

– Adopting HICS will ensure element compliance– Example: Emergency Operations Plan (EOP)

explains the use of ICS, IAP and common communication planning

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gNIMS Implementation Elements

Command and Management

• Element 3 – Multiagency Coordination System– Develop and coordinate connectivity capability with

the HCC and the local ICP, 911 centers, EOCs and the State EOC and others, if applicable

– Implementation Guidance:• Once local/regional MAC is established, hospitals should

participate in collaborative planning• Exercises and training should be conducted

– Example:• The EOP demonstrates the management and

coordination between the HCC and multiagency coordination system entities

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gNIMS Implementation Elements

Command and Management• Element 4 – Public Information System

– Implements plans to communicate through a JIS or JIC

– Implementation Guidance:• Hospital should identify at least one PIO,

representative or spokesperson responsible for media and public info

• Establish pre-event working relationships with local media, emergency management, law enforcement, public health, EMS etc.

– Example:• The EOP explains the management of public info with

partners

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gNIMS Implementation Elements

Preparedness Planning

• Element 5 – NIMS Implementation Tracking– Hospitals and healthcare systems will track NIMS

implementation annually as part of the EMP– Implementation Guidance:

• Hospital must self certify compliance• Designate a NIMS implementation designee

– Example: The hospital will track implementation activities annually with a goal of improving emergency management capability

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gNIMS Implementation Elements

Preparedness Planning

• Element 6 – Preparedness Funding– Develop and implement a system to coordinate

hospital preparedness funding to employ NIMS across the organization

– Implementation Guidance:• Collaborate with state and local government and hospital

associations to identify and obtain preparedness funding– State Department of Health – State Office of Homeland Security– State Office of Emergency Management– Local public health– Local emergency management

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gNIMS Implementation Elements

Preparedness Planning

• Element 6 – Preparedness Funding (continued)

– Example: The EMP includes information on local, state and federal preparedness grants received and deliverables to be achieved

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gNIMS Implementation Elements

Preparedness Planning• Element 7 – Revise and Update Plans

– Revise EOP and Standard Operating Procedures (SOPs) to incorporate NIMS

• Planning • Training• Response• Exercises• Equipment• Evaluation and corrective actions

– Implementation Guidance and Example:• The EMP work plan reflects status of revisions to EOPs

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gNIMS Implementation Elements

Preparedness Planning

• Element 8 – Mutual Aid Agreements/MOUs– Participate in and promote interagency mutual aid

agreements (public and private sector and NGOs)– Implementation Guidance:

• Establish mutual aid agreements/MOUs with:– Neighboring hospitals/healthcare systems– Public health departments– HazMat Response Teams– Local Fire and Law Enforcement– Area pharmacies– Medical supply vendor

• Share agreements with local emergency management prior to an incident occurring

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gNIMS Implementation Elements

Preparedness Planning

• Element 8 – Mutual Aid Agreements (Continued)

– Example: • EMP documentation includes information supporting

any mutual aid agreements and/or MOUs that the facility has

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gNIMS Implementation Elements

Preparedness Training

• Element 9 – IS-700: NIMS: An Introduction– Complete IS-700– Implementation Guidance:

• IS-700 should be completed by hospital personnel in a leadership role in emergency preparedness, incident management, filling ICS/HICS roles and/or emergency response

• Phased in training• Train others as indicated (MDs, RNs, others)

– Example: The EMP training records track completion of IS-700.

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gNIMS Implementation Elements

Preparedness Training• Element 10 – IS-800.A: NRP

– Complete IS-800 – Implementation Guidance:

• IS 800 should be completed by personnel whose primary responsibility is emergency management

• Hospital must track training

– Example:• Emergency preparedness program training records

track completion of IS 800 or equivalent • Training by individual(s) responsible for the hospital’s

emergency management program

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gNIMS Implementation Elements

Preparedness Training• Element 11 – ICS 100 HC and 200 HC

– Complete ICS 100 and 200 training or equivalent courses

– Implementation:• IS 100: Completed by hospital personnel that would

have a direct role in emergency preparedness, incident management and/or designated to fulfill ICS roles

• IS 200: Completed by personnel whose primary responsibility is emergency management

– Including middle management and administration– Personnel designated to fulfill ICS roles

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Recommended Levels of Training for Hospital Personnel*

 

   

 

IS 100 or

equivalent

IS 200 or

equivalent

IS 300 or

equivalent

IS 400 or

equivalent

IS 700 or

equivalent

IS 800 or

equivalent 

 

Hospital personnel who are likely to assume an ICS position in the

Hospital Command Center or have a

primary responsibility for

emergency management

X X     X    

 Emergency Program

Manager X X     X X  

 

Hospital Emergency Preparedness

Committee Members/persons responsible for the

Emergency Management Plan

X X     X    

Emergency Management Training Requirements for Hospital Personnel

Training to be completed by August 31, 2007

* References: 1) NIMS Integration Center, NIMS Alert: NIMS Implementation Activities for Hospitals and Healthcare Systems, September 12, 2006. 2) Health Resources and Services Administration, National Hospital Bioterrorism Preparedness Program, Fiscal Year 2005 Continuation Guidance, HRSA Announcement Number 5-U3R-05-001.

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gNIMS Integration Center

• Required training resources– Emergency Management Institute

• www.training.fema.gov/EMIWeb/IS/

– Self-developed/State certified courses (equivalent courses)

– Center for HICS Education and Training

• For questions or correspondence on NIMS– NIMS Integration Center

• www.fema.gov/emergency/nims/index.shtm

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gNIMS Implementation Elements

Preparedness Exercises

• Element 12 – Training and Exercises– Incorporate NIMS/ICS into internal and external

local, regional and state emergency management training and exercises

– Implementation Guidance:• Include NIMS and ICS into trainings and exercises• Review plans with staff to ensure competency

– Example: The EMP documentation reflects the use of NIMS/ICS

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gNIMS Implementation Elements

Preparedness Exercises

• Element 13 – All-Hazards Exercise Program– Participate in all-hazards exercises with response partners– Implementation Guidance:

• Participate in local, regional and/or state multidiscipline/agency exercises 2/year to every 2 years.

• Exercise (drills, tabletops, functional or full-scale)– Internal and external communications

– Receiving, triage, treatment and transfer of mass casualties

– Progress of casualties through the system

– Resource management

– Security

– Specialty lab testing

– Site/facility safety

– Example: EMP documents reflects participation

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gNIMS Implementation Elements

Preparedness Exercises

• Element 14 – Corrective Actions– Hospitals will incorporate corrective actions into

response plans and procedures– Implementation Guidance:

• After exercises, develop a corrective action report– Actions to correct the issue/deficiency– Responsible person/group to implement the action– Due date for completion– Incorporate correction into P&P

– Example: EMP documents a corrective action process

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gNIMS Implementation Elements

Resource Management• Element 15 – Response Inventory

– Maintain an inventory of organizational response assets– Implementation Guidance:

• Determine emergency par levels for supplies and equipment• Consider stockpiling• Develop MOUs for supply and resupply

– Example: EMP documentation includes a resource inventory

• Medical/surgical supplies• Pharmaceuticals• PPE• Equipment• Staffing• Etc.

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gNIMS Implementation Elements

Resource Management• Element 16 – Resource Allocation

– As permissible, incorporate national standards and guidance into acquisition programs

– Implementation Guidance:• As possible, establish common equipment,

communications and data interoperability resources with other local response partners

– Example: EMP emphasizes interoperability

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gNIMS Implementation Elements

Communications and Information Management

• Element 17 – Standard and Consistent Terminology– Apply standard and consistent terminology, in plain

English standards – Implementation Guidance:

• Establish common language consistent with local emergency management, public safety and public health

• Use plain language (internal Emergency Codes OK)

– Example: EMP emphasizes the use of plain English by staff during emergencies

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gSection Summary

• NIMS Activities for Hospitals and Healthcare System

– Include 17 elements of activities – Adopting these elements will improve a hospital’s

• Preparedness• Response• Recovery

• Mandated elements by August 31, 2007:– Training of selected key personnel in

• ICS 100 HC and 200 HC• IS 700: NIMS• IS 800: NRP

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Questions?

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g

The

Hospital Incident

Command

System

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Origins of HICS

How did HICS evolve and why is it important to

your hospital?

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• Inception of HEICS in 1980’s with 2 revisions in 1990’s

• Over 6000 hospitals across the country utilize HEICS as their response model

• Obvious needs surfaced pre- and post 9/11−All hazards approach−Coordinated, community planning

From HEICS to HICS

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• Key concept: Revision of previous models• Incident Management System for:

– Daily operations– Preplanned events – Non-emergent situations

• A systems approach to managing an incident• HEICS became HICS

– Not just for emergencies anymore

HEICS IV Project

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Intent and Objectives

• Maintain the fundamental concepts Predictable chain of command Modular and scalable to the incident Position accountability Common language

• Use the Incident Command System (ICS) principles and practices• ICS adapted to the unique hospital setting

HEICS IV Project

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Intent and Objectives

• Intended Outcomes Incorporate current emergency management

practices Address NIMS compliance issues Integrate CBRNE events Maintain system scalability for all Develop core materials Address instructor qualifications

HEICS IV Project

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• National Working Group Hospital subject matter experts

• Ex-Officio Members AHA, JCAHO, DHS, DHHS, ASHE, NIC, EMI, HRSA

• Secondary Review Group Subject matter experts from the healthcare community

• Executive Group California EMS Authority and Contract Support Group

• Contract Support Group ER One Institute at the Washington Hospital Center Kaiser National Healthcare Continuity Management

HEICS IV Project Team

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• All-hazards and ‘systems’ approach

• A management tool

• Emphasizes preparedness efforts with community partners

• Scalable and adaptable for all hospitals

• Assists with NIMS compliance for hospitals and healthcare systems

What’s New in HICS?

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• Uses the Incident Command System (ICS) principles and practices−ICS adapted to the unique hospital setting

• Approved by the NIMS Integration Center (NIC), HRSA and Joint Commission

What’s New in HICS?

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• HICS Guidebook• Incident Management Team Chart

Replaces the HEICS Organizational Chart Revised for consistency with NIMS

• Updated Job Action Sheets• Incident Planning and Response Guides• Updated HICS Forms

– Consistent with NIMS / Standard ICS• HICS Educational Materials• NIMS Implementation Activities

New HICS Products

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• Comply with regulatory standards and nongovernmental guidelines– The Joint Commission

• Environment of Care 4.10

Health Resources and Services Administration Cooperative Agreements

o NIMS compliance and Training requirements

Emergency Medical Treatment and Active Labor Act Health Insurance Portability and Accountability Act

Why Is HICS Important to Your Hospital?

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gWhy Is HICS Important to Your

Hospital?• Comply with regulatory standards and

nongovernmental guidelines OSHA

o 29 CFR Part 1910 - Hazardous Materials Regulations

Centers for Medicare and Medicaid Services National Fire Protection Association (NFPA 1600)

o Standard 99 - Healthcare facilitieso Standard 1600 – Disaster/Emergency Management

American Society for Testing and Materials (ATSM) o F-1288 – Guide for Planning and Response to an MCI

Superfund Amendments and Reauthorization Act

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• Assists in coordinating the hospital’s planning and response efforts and actions Sets direction and goals in initial efforts Assists with Incident Action Planning Mission focused

• Manages the incident using the Incident Command System– Defines roles and responsibilities– Facilitates community responder communication

and mutual aid

Why Is HICS Important to Your Hospital?

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gWhy Is HICS Important to Your

Hospital?

• Facilitates coordination with partners Local and community (sister or “buddy”) hospitals

and healthcare systems Regional Hospital Coordination Centers Public safety agencies Local Emergency Management Nongovernmental organizations (NGO)

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g • Serves as the foundation for your Emergency Operations Plan– HICS is NOT the EOP

– HICS is a system management tool

Why Is HICS Important to Your Hospital?

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gHICS Resources

• HICS Guidebook and materials– California Emergency Medical Services Authority

website at:• www.emsa.ca.gov/hics/hics.asp

– The Center for HICS Education and Training• www.hicscenter.org

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gSection Summary

• HICS is useful for daily operations, preplanned events and non-emergent situations

• HICS uses the Incident Command System (ICS) principles and practices−ICS adapted to the unique hospital setting

−HICS complies with regulatory mandates

• Assists in coordinating the hospital’s internal and external planning, response and recovery

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Questions?

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g

The

Hospital

Incident Command System

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g The HICS Guidebook

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gThe HICS Guidebook

• Explains the critical components of HICS

• Describes the use of HICS products and materials

• Assists with emergency management planning

• Guide for:– Hospital planners and responders– Community responders to understand and integrate

hospitals into larger response

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gThe HICS Guidebook

• The Guidebook is NOT– The definitive text on emergency preparedness– Designed to comprehensively teach the principles of

incident command– Not the Emergency Management or Operations Plan

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• Chapter 1 - Introduction to HICS– History of the HEICS IV Project and transition to

HICS– Scope and applicability– HEICS IV Project Team

• Chapter 2 - Principles of Incident Command– History of ICS– Incident management functions– Incident action planning process

The HICS Guidebook

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• Chapter 3 - NIMS Compliance for Hospitals– NIMS organizational system overview– NIMS compliance activities for hospitals

• Chapter 4 - Hospital Emergency Management Program– Program development– All-hazards Emergency Operations Plan– Hazard Vulnerability Analysis– Planning Partners

The HICS Guidebook

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• Chapter 5 - Hospital Incident Command System– Incident Management Team

• Command• Operations• Planning• Logistics• Finance / Administration

– Incident Command Principles and Practice

The HICS Guidebook

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• Chapter 6 - Life Cycle of an Incident– Alert and Notification−Situation Assessment and Monitoring−Emergency Operations Plan Implementations−Establishing the Hospital Command Center−Building the ICS Structure− Incident Action Planning−Communications and Coordination−Staff Health and Safety−Operational Considerations−Legal and Ethical Considerations−Demobilization−System Restoration−Response Evaluation and Organizational Learning

The HICS Guidebook

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• Appendices

– A: Incident Planning Considerations−B: HICS Incident Management Team Chart−C: Using the Job Action Sheets−D: Using the HICS Forms−E: HEICS to HICS: Implementation Steps−F: Potential Candidates for HICS Command

Positions

The HICS Guidebook

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gThe HICS Guidebook

• Appendices

−G: HEICS III to HICS Position Crosswalk−H: Working with the Scenarios, Incident Planning

and Response Guides−I: NIMS Implementation Activities for Hospitals

and Healthcare Systems−J: Recommended Resources−K: HEICS IV revision project organization

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gThe HICS Guidebook

• Educational materials – Module based Power Points presentations

highlighting key HICS concepts– Print materials to accompany the power points– 27 scenarios to use to assist with exercise planning

• 14 External scenarios• 13 Internal scenarios

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• HICS is a living document and system– Grows and evolves as practices and hospital

needs change• Modifications made as lessons are learned• Adapted for your hospital’s unique needs• Continue to advance hospital preparedness

and emergency management standardization

The Future of HICS

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gSection Summary

• The HICS Guidebook provides – The critical components of HICS– An overview of Emergency Management

principles– Guidance on how to use the HICS products and

materials

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Questions?

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Building the

Incident Management

Team

Incident Commander

Planning Section Chief

LogisticsSection Chief

Operations Section Chief

Finance/

Administration Section Chief

Liaison Officer

Medical/Technical Specialist

Safety Officer

Public Information Officer

Procurement Unit Leader

Compensation/Claims

Unit Leader

Time Unit Leader

Cost Unit Leader

Service Branch Director

Support Branch Director

Resources Unit Leader

Situation Unit Leader

Documentation Unit Leader

Demobilization Unit Leader

Staging

Manager

Medical Care Branch Director

Infrastructure Branch Director

HazMat Branch Director

Security Branch Director

Business Continuity

Branch Director

Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit

Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit

Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit

Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit

Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit

Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging Team

Personnel TrackingMateriel Tracking

Patient TrackingBed Tracking

Communications UnitIT/IS UnitStaff Food & Water Unit

Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit

Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist

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gHICS IMT

• The IMT – Depicts hospital management functions and how

authority and responsibility is distributed– Each of the 5 management functions is color

coded • Command (white or grey)• Operations (red)• Planning (blue)• Logistics (yellow)• Finance/Administration (green)

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g HICS IMT Hierarchy

Note: Divisions and Groups are used in ICS but not reflected in the HICS IMT

Incident Commander

Branch Director

Unit Leader

Strike Team

General Staff Section Chief

Command Staff Officers

Task Force

Single Resources

Manager

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gIMT Titles

• The IMT titles are distinct and standardized. This serves three important purposes: **– Allows for filling IMT positions with the most qualified

persons and not by rank– Assists with requesting outside resources to staff

these positions– Assists with clarifying the activities undertaken by

specific personnel

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gIMT Hierarchy

• The Incident Commander– Is the only position always activated for every

incident** – Has overall responsibility to manage the incident

• Command Staff– Title: Officer– Positions:

• Public Information Officer• Safety Officer• Liaison Officer• Medical/Technical Specialists

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gIMT Hierarchy

• General Staff**:– Organizational Component: Section– Title: Section Chief– Role: Responsible for major functional areas of

the incident– IMT Positions:

• Operations• Planning• Logistics• Finance/Administration

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gIMT Hierarchy

• Deputy Chief Role:– The individual assuming the Deputy role will

assist the Command Staff, Section Chiefs or Branch Directors** by performing delegated job activities or tasks as outlined by that JAS

• Assistant Role:– A subordinate to a Command Staff or Section

Chiefs who performs technical capabilities and responsibilities

– They may also be assigned to a Unit Leader as situational needs dictate and resources allow

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gIMT Hierarchy

• Branches:– Title: Branch Director– Role:

• Branches can be established– Geographically or functionally**– When the number of Divisions or Groups exceed the span of

control for the Section Chief*

• Branches may also be established*– In multi-disciplinary incident– In multi-jurisdictional incidents– Very large incidents

– IMT Positions:• Specific to the Section’s duties• Example:

– Medical Care Branch Director in Operations– Service Branch Director in Logistics

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gIMT Hierarchy

• Divisions/Groups:– Title: Division Supervisor– Role:

• Division: Divide the incident geographically – Example: first floor and second floor

• Group: Divide the structure into functional areas of operation by the resources to perform the function

– IMT Positions:• Divisions and Groups are not commonly used in the

hospital setting• Divisions and Groups are NOT REFLECTED in the

HICS IMT

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gIMT Hierarchy

• Units:– Title: Unit Leader– Role: Functional responsibility for a specific

incident activity under a Section and Branch– IMT Positions:

• Specific to the Branch’s duties• Example:

– Inpatient Unit Leaders in the Medical Care Branch in the Operations Section

– Situation Unit Leader in the Planning Section– Labor Pool and Credentialing Unit in the Support Branch in

the Logistics Section

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gIMT Hierarchy

• Single Resources, Strike Teams, Task Forces– Title: Leader– Role:

• Single Resources: – An individual or piece of equipment with its personnel complement

(i.e., perfusionist)– A crew or team of individuals with a identified supervisor

• Strike Teams: – A set number of similar resources (i.e., burn RNs)

• Task Forces:– A combination of mixed resources (i.e., RNs, MDs, Techs,

Secretaries)

– IMT Positions:• These are NOT REFLECTED on the HICS IMT• Can be employed by the hospital as dictated by the incident• These teams report to the Unit Leader

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g

• The Incident Commander is responsible for building the Incident Command Team

• The IMT is built according to the incident:– Scope and magnitude of the event– Potential/real impact to the hospital – Hospital size– Available resources– Special response needs (i.e., HazMat, biological,

legal, IT)

Building the IMT

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gBuilding the IMT

• Every incident requires certain management functions be performed– The incident/problem must be evaluated– A plan must be developed to address the problems– The necessary resources must be assigned– Outcomes and effectiveness must be evaluated

• Management by objectives is essential for successful Incident Action Planning**, response and recovery

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gBuilding the IMT

• The IC should appoint properly trained persons to critical Command and General Staff positions

Incident Commander

OperationsSection Chief

PlanningSection Chief

LogisticsSection Chief

Liaison Officer

Safety OfficerPublic Information Officer

Medical/Technical Specialist

Finance/AdministrationSection Chief

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gBuilding the IMT

• Once appointed:– Section Chiefs and Branch Directors staff their

own sections

• IMT position titles are standardized– Describe the position’s role and mission rather

than the person– Allows the position to be filled by the most

qualified rather than by seniority– Facilitates requests for outside qualified

personnel

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gBuilding the IMT

• The IMT reflects a reasonable“Span of Control”– Definition: The number of individuals or resources one

supervisor can effectively manage**– Ratio of 3-7 reporting elements per 1 supervisor

• The IMT structure does not exactly mirror the daily administrative structure– This is purposeful– Reduces role and title confusion during

the response** −HICS IMT Crosswalk suggests position assignments

IMT CrosswalkIncident Commander

Planning

Section Chief

Logistics

Section Chief

Operations Section

Chief

Finance/Administration

Section Chief

Public Information

Officer

Liaison

Officer

Medical/Technical

Specialist

Safety

Officer

Ÿ Hospital Administrator/Administrator On-Call

Ÿ Nursing SupervisorŸ Chief Executive Officer

Ÿ Chief Operating Officer

Ÿ Chief Medical OfficerŸ Chief Nursing Officer

Ÿ Emergency Management Coordinator

Ÿ Safety DirectorŸ Security Chief

Ÿ Building Engineer

Ÿ Emergency ManagementCoordinator

Ÿ Radiation Safety OfficerŸ Employee Health

Ÿ Infection Control

Ÿ Risk ManagementŸ Industrial Hygienist

Ÿ Industrial Hygienist

Ÿ Infectious Disease

SpecialistŸ Infection Control

Ÿ Epidemiology

Ÿ Chief of StaffŸ Chief of Pediatrics

Ÿ Radiation Safety Officer

Ÿ Nuclear Medicine

Ÿ Health PhysicistŸ Structural Engineer

Ÿ Outpatient Services Administrator

Ÿ Chief of Trauma

Ÿ Primary Care Director

Ÿ Behavior Health Director

Ÿ LegalŸ Risk Manager

Ÿ Poison Control Director

Ÿ IT/IS Director

Ÿ Hospital Public Information OfficerŸ Marketing Director

Ÿ Patient Relations

Ÿ Risk Management

Ÿ Chief Information Officer

Ÿ Community Relations

Ÿ Chief Executive OfficerŸ Emergency Management

Coordinator

Ÿ Chief Operating Officer

Ÿ Chief Medical OfficerŸ Chief Nursing Officer

Ÿ Nursing SupervisorŸ Emergency Management Coordinator

Ÿ Strategic Planning

Ÿ VP of AdministrationŸ Human Resources Director

Ÿ Nursing DirectorŸ Chief Nursing Officer

Ÿ Nursing Supervisor

Ÿ VP of FacilitiesŸ Emergency Management

Coordinator

Ÿ Chief Procurement Officer

Ÿ Support Services DirectorŸ Supply Director

Ÿ Chief Operating OfficerŸ Facilities Director

Ÿ Warehouse Director

Ÿ Chief Finance Officer

Ÿ VP of FinanceŸ VP of Business Services

Ÿ VP of AdministrationŸ Controller/Comptroller

Ÿ Chief Information Officer

Ÿ Hospital Administrator/Admintrator on Call

Ÿ Safety Director

Ÿ Chief Engineer

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gBuilding the IMT

• Positions appointed to meet the incident needs do not have to be sequential from the top down*– Appoint those positions to meet the immediate

needs of the incident• Example……..

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gBuilding the IMT - Example

Incident Commander

Safety Officer

Labor Pool and Credentialing Unit

Leader

Medical Care Branch Director

Infrastructure Branch Director

Situation: It is 4:00 am and a large fire erupts in the laboratory, located very close to two patient care

areas with a high census.

IC activates IMT positions needed immediately!

I am needed to call in

additional staff to assist

with evacuation

I will oversee the

medical care

I ensure HVAC, Med

Gases and

assess damage

I ensure safety of the

patients, staff and facility

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gIMT Communications

• Communication and information-sharing in the IMT should occur:– Up and down the chain of command– Across Sections to the appropriate

Section/Branch/Unit**

• Information should be displayed on status boards and easily accessed

• Communications should be documented for accountability and archiving

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gSection Summary

• Incidents may be different but the IMT fundamentals remain the same:– Positions activated and structure of IMT meet the

needs of the incident– Positions are filled by qualified and trained

personnel• Based on qualifications rather than by seniority

• The HICS IMT has a defined hierarchy and chain of command and reporting

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g

Questions?

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g Command

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gCommand

• Command functions– Maintain overall management of the incident– Set the incident objectives and priorities– Devise and approve strategies– Ensure mission completion

• Incident Commander in charge • Command consists of:

– Command staff – General staff

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g

CommandIncident Commander

Liaison Officer

Medical/Technical Specialist

Safety Officer

Public Information Officer

Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist

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gIncident Commander

• Mission: – Organize and direct the Hospital Command

Center (HCC). Give overall strategic direction for hospital incident management and support activities, response and recovery. Authorize total facility evacuation if warranted

– The first Incident Commander is responsible until the authority is delegated to another person**

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gIncident Commander

• Duties:– Ensure incident safety *– Initiate HICS and activation of the HCC– Determine scope and magnitude of event and

potential impacts on the facility– Determine and activate appropriate IMT positions– Initiate and approve the IAP– Providing information services to internal and

external stakeholders*– Liaison with Governing Board and other

organizations*

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gPublic Information Officer

• Mission: – Serve as the conduit for information to internal and

external stakeholders**, including staff, visitors and families, and the news media, as approved by the Incident Commander

• Duties: – Determine parameters of information release from the IC– Determine any restrictions in content (sensitive materials)– Collaborate with local community officials (JIC) on risk

communication messages for consistent content– Maintain contact with Situation Unit Leader for current

information and facility status– Schedule regular media briefings and press releases

• Report to: Incident Commander

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gSafety Officer

• Mission:– Ensure safety of staff, patients, and visitors,

monitor and correct hazardous conditions. Have authority to halt any operation that poses immediate threat to life and health

• Duties:– Determine safety risks of the incident to

personnel, the hospital facility, and the environment

– Initiate corrective/protective actions for safety issues

• Report to: Incident Commander

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gLiaison Officer

• Mission:– Function as the incident contact person in the Hospital

Command Center for representatives from other agencies• Duties:

– Is the primary contact for supporting agencies and organizations assisting at an incident but not participating in the HCC/ICS structure**

– Establish contacts with liaison counterparts in each assisting and cooperating agency (including other hospitals, RHCCs, EOCs and others)

– Update governmental liaisons on the hospital status and response

– Make facility needs and requests for assistance and resources

• Reports to: Incident Commander

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gMedical/Technical Specialists

• The Specialist Position is new and unique to HICS – A category of personnel w/specialized expertise – Activated based on situational need– Primarily are consultants but can have delegated

authority – Can have more than one in activated at a time – May report to any position in the IMT

• Hospitals can create other categories as needed

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gMedical/Technical Specialists

• Specialist Roles– Biological/Infectious disease– Chemical– Radiological – Clinic Administration– Hospital Administration– Legal affairs– Risk management – Medical Staff– Pediatric Care – Medical Ethicist – ** Others can be developed as needed by the

hospital

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gMedical/Technical Specialists

• Mission:– Advise the Incident Commander and/or assigned

Section on issues related to emergency response in their area of expertise

• Duties:– May be assigned as technical advisor in the HCC– May be assigned to advise and oversee specific

hospital operations• Example: Decontamination operations during a

chemical exposure situation

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gSection Summary

• The Incident Commander is the only position that will ALWAYS be activated

• The Incident Commander has overall responsibility for:– Management of the Incident– Activities within the HCC– Continuing as IC until authority is delegated to

another

• The Command Staff consists of:– PIO– Liaison

− Safety Officer− Medical/Technical Specialists

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Questions?

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gLet’s talk about Sections

Incident Commander

Planning Section Chief

LogisticsSection Chief

Operations Section Chief

Finance/

Administration Section Chief

Liaison Officer

Medical/Technical Specialist

Safety Officer

Public Information Officer

Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist

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gSections

• Sections are:– Operations– Planning– Logistics– Finance/Administration

• Sections are led by a Chief

• Section Chiefs are known as General Staff **

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g

TheOperations

Section

OperationsSection Chief

Staging Manager

Security BranchDirector

Business ContinuityBranch Director

InfrastructureBranch Director

HazMat BranchDirector

Medical CareBranch Director

Outpatient Unit Leader

Casualty Care UnitLeader

Inpatient Unit Leader

Mental Health UnitLeader

HVAC Unit Leader

Building/GroundsDamage Unit Leader

Water/Sewer UnitLeader

Medical Gases UnitLeader

Power/Lighting UnitLeader

Medical Devices UnitLeader

Access Control UnitLeader

Crowd Control UnitLeader

Traffic Control UnitLeader

Search Unit Leader

Law EnforcementInterface Unit Leader

Information TechnologyUnit Leader

Service Continuity UnitLeader

Records PreservationUnit Leader

Business FunctionRelocation Unit Leader

Spill Response UnitLeader

Victim DecontaminationUnit Leader

Detection andMonitoring Unit Leader

Facility/EquipmentDecontamination Unit

Leader

Vehicle Staging TeamLeader

Equipment/SupplyStaging Team Leader

Personnel StagingTeam Leader

Medication StagingTeam Leader

Clinical SupportServices Unit Leader

Patient RegistrationUnit Leader

Environmental ServicesUnit Leader

Food Services UnitLeader

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gOperations Section

• Section Mission:– Manage tactical operations** – Direct all tactical resources– Carry out the mission and Incident Action Plan

• Lead by a Section Chief

• Largest section of resources to marshal and coordinate – Tactical resources are classified**:

• Assigned• Available• Out-of-Service

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gOperations Section

• The Section includes:– Staging Area– Medical Care Branch – Infrastructure Branch – HazMat Branch – Security Branch– Business Continuity Branch

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gOperations Section Chief

• Mission:– Develop and implement strategy and tactics to carry out

the objectives established by the Incident Commander. Organize, assign, and supervise Staging, Medical Care, Infrastructure, Security, Hazardous Materials, and Business Continuity Branch resources

• Duties:– Appoint Section personnel as indicated by event– Conduct Section briefings, update Unit Leaders– Maintain current status of all areas in the Section– Communicate with and advise the IC on Section

issues/needs

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gOperations Section Chief

• Supervises:– Staging Manager– Medical Care Branch Director– Infrastructure Branch Director– HazMat Branch Director– Security Branch Director– Business Continuity Branch Director

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gStaging Manager

• Mission:– Organize and manage the deployment of

supplementary resources, including personnel, vehicles, equipment, supplies, and medications

• Supervises:– Personnel Staging Team– Vehicle Staging Team– Equipment/Supply Staging Team– Medication Staging Team

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gStaging Manager

• Duties:– Coordinate delivery of needed resources to

requesting area• Once resources are acquired by Logistics, they are

then staged with the Staging Manager

– Establish a staging area in a central location• Area must be large enough to “stage” resources

– Works closely with the Logistics Section– If staging area resources become too great,

appoint appropriate Team Leaders

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gMedical Care Branch Director

• Mission:– Organize and manage the delivery of emergency,

inpatient, outpatient, and casualty care, and clinical support services

• Duties: – Addresses provision of acute AND continuous

care – Works closely with Logistics Section to ensure

resource acquisition – Works closely with Staging Manager for delivery

of resources to areas

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gMedical Care Branch Director

• Supervises:– Inpatient Unit Leader (all inpatient units)– Outpatient Unit Leader (all outpatient services)– Casualty Care Unit Leader (Emergency Dept.)– Mental Health Unit Leader – Clinical Support Unit Leader (Lab, Diagnostic

Imaging, Pharmacy, Morgue, Blood Donor)– Patient Registration Unit Leader

• Reports to the Operations Section Chief

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gInfrastructure Branch Director

• Mission:– Organize and manage the services required to sustain and

repair the hospital’s infrastructure operations

• Duties:– Maintains overall facility operations and normal operating

capacity– Identify and fix utility service-delivery failures

• Coordinate the acquisition of parts or contractors with the Logistics Section

– Assign a strike team to address damage to the facility as needed

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gInfrastructure Branch Director

• Supervises:– Power/Lighting Unit Leader– Water/Sewer Unit Leader– HVAC Unit Leader– Building/Grounds Unit Leader– Medical Gases Unit Leader– Medical Devices Unit Leader– Environmental Services Unit Leader– Food Services Unit Leader (for inpatients)

• Reports to Operations Section Chief

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gHazMat Branch Director

• Mission:– Organize and direct hazardous material incident response

activities: detection and monitoring; spill response; victim, technical, and emergency decontamination; and facility and equipment decontamination

• Duties:– Oversee the operations involving a hazmat event

• Decontamination of victims, staff, facility• Safe and appropriate use of PPE• Clean up operations

– Collaborates closely with Medical Care Branch Director

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gHazMat Branch Director

• Supervises:– Detection and Monitoring Unit Leader– Spill Response Team Unit Leader– Victim Decontamination Unit Leader– Facility/Equipment Decontamination Unit Leader

• Reports to Operations Section Chief

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gSecurity Branch Director

• Mission:– Coordinate all of the activities related to internal

and external personnel and facility security

• Duties:– Implement facility security measures – Ensure security and access control of the HCC– Liaison with responding law enforcement

personnel– Oversee search and rescue operations for the

facility

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gSecurity Branch Director

• Supervises– Access Control Unit Leader– Crowd Control Unit Leader– Traffic Control Unit Leader– Search Unit Leader– Law Enforcement Interface Unit Leader

• Reports to the Operations Section Chief

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gBusiness Continuity Branch Director

• Mission:– Ensure business functions are maintained, restored or

augmented to meet designated Recovery Time Objectives (RTO) and provide limited interruptions to continuity of essential business operations

– Can be activated immediately or as needed during the response

• Duties:– Facilitate the acquisition of and access to essential

recovery resources, including business records– Support Branches with relocation to alternate business

sites– Coordinate IT services with Logistics Section– Assist Branches and impacted areas to restore normal

operations

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gBusiness Continuity

Branch Director• Supervises:

– Information Technology Unit Leader• Mission: Ensure IT business functions are maintained,

restored or augmented • Works closely with Logistics Section IT/IS Unit

– Service Continuity Unit Leader• Mission: Ensure business/clinical/ancillary service

functions are maintained, restored or augmented

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gBusiness Continuity

Branch Director• Supervises:

– Records Preservation Unit Leader• Mission: Ensure vital business/medical records are

maintained and preserved

– Business Function Relocation Unit Leader• Mission: Ensure business functions are moved to

alternative work sites

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gSection Summary

• The Operations Section is responsible for – All tactical operations,**– The tactical objectives and organization – Directing all tactical resources

• Operations Section is led by a Chief

• Operations Section positions are activated as needed by the incident

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g

Questions?

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g The Logistics Section

Logistics SectionChief

Support BranchDirector

Service BranchDirector

IT/IS Unit Leader

Staff Food &Water Unit

Leader

CommunicationsUnit Leader

Family Care UnitLeader

Supply UnitLeader

Employee Health& Well-Being Unit

Leader

Facilities UnitLeader

TransportationUnit Leader

Labor Pool &Credentialing Unit

Leader

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g Logistics

• Provides support to other sections • Acquires resources from internal and external

sources – Activate existing MOUs, contracts and vendor

agreements– Employs standard and emergency procurement and

contracting procedures

• With Liaison, links to local EOC and/or Regional Hospital Coordination Center for resource requests

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gLogistics and Operations

• Logistics and Operations are closely linked and must work collaboratively together– Logistics Section is the “getters” – Operations Section is the “doers”

• Scope and Responsibilities overlap– Logistics Supply Unit and Operations’ Infrastructure

Branch– Labor Pool and Credentialing Unit and Staging

Manager– Personnel Team Leader

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gLogistics Section Chief

• Mission: – Organize and direct those operations associated

with maintenance of the physical environment and with the provision of human resources, materiel, and services to support the incident activities. Participate in Incident Action Planning

• Duties:– Oversee the acquisition of resources– Maintain current status of all areas in the section

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gLogistics Section Chief

• Supervises:– Service Branch Director– Support Branch Director

• Reports to the Incident Commander

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gService Branch Director

• Mission: – Organize and manage the services required to

maintain the hospital’s communication system, food and water supply for staff, and information technology and systems

• Oversees:• Communications Unit Leader• IT/IS Unit Leader• Staff Food and Water Unit Leader

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gService Branch Unit Leaders

• Communications Unit Leader– Mission: Organize and coordinate internal and external

communications connectivity

• IT/IS Unit Leader– Mission: Provide computer hardware, software and

infrastructure support to staff– Coordinates closely with Operations Section Business

Continuity Branch, IT Unit

• Staff Food and Water Unit Leader– Mission: Organize food and water stores and prepare for

rationing during periods of anticipated or actual shortage– Coordinates closely with Operations Section

Infrastructure Branch, Food Services Unit

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gSupport Branch Director

• Mission: – Organize and manage the services required to maintain

the hospital’s supplies, facilities, transportation, and labor pool. Ensure the provision of logistical, psychological, and medical support of hospital staff and their dependents.

• Oversees:– Employee Health and Well-Being Unit Leader– Family Care Unit Leader– Supply Unit Leader– Facilities Unit Leader– Transportation Unit Leader– Labor Pool and Credentialing Unit Leader

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gSupport Branch Unit Leaders

• Employee Health and Well Being Unit (Known as the “Medical Unit” in ICS**)

– Mission: • Provide medical screening, evaluation and follow-up of employees

who are assigned to the incident**• Ensure the availability of medical care for injured or ill staff• Ensure the availability of behavioral and psychological support

services to meet staff needs during and following an incident. • Coordinate mass prophylaxis/vaccination/immunization of staff, if

required. Coordinate medical surveillance program for employees

• Family Care Unit – Mission:

• Ensure the availability of medical, logistic and mental health and day care for the families of staff members. Coordinate mass prophylaxis/vaccination/immunization of family members if required

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gSupport Branch Unit Leaders

• Supply Unit – Mission:

• Acquire, inventory, maintain, and provide medical and non-medical care equipment, supplies, and pharmaceuticals

• Facility Unit – Mission:

• Organize, manage and support building systems, equipment and supplies. Ensure proper cleaning and disinfection of hospital environment.

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gSupport Branch Unit Leaders

• Transportation Unit – Mission:

• Organize and coordinate the transportation of all ambulatory and non-ambulatory patients. Arrange for the transportation of human and materiel resources within or outside the facility

• Labor Pool and Credentialing Unit– Mission:

• Collect and inventory available staff and volunteers at a central point (Labor Pool) for assignment by the Staging Officer. Maintain adequate numbers of both medical and non-medical personnel. Assist in the maintenance of staff morale

• Coordinates closely with Operations Section Staging Manager

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gSection Summary

• The Logistics Section supports the

resource requirements of the response

• Logistics Section has two branches:– Support– Service

• The Logistics Section is led by a Chief**

• Logistics works closely with the Operations Section

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Questions?

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Planning Section

Planning SectionChief

Situation UnitLeader

DocumentationUnit Leader

Resources UnitLeader

DemobilizationUnit Leader

PersonnelTrackingManager

Materiel TrackingManager

Patient TrackingManager

Bed TrackingManager

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gPlanning Section

• Section Mission:– Collect, evaluate, and disseminate incident

action information and intelligence to Incident Commander*

– Prepare status report and display various information

– Develop the Incident Action Plan (IAP)

• Lead by a Section Chief

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gPlanning Section Chief

• Mission:– Oversee all incident-related data gathering and

analysis regarding incident operations and assigned resources, develop alternatives for tactical operations, conduct planning meetings, and prepare the Incident Action Plan (IAP) for each operational period

• Duties:– Ensure distribution of critical information/data– Compile scenario projections from all Section

Chiefs and effect long range planning– Document and distribute the facility action plan– Conduct Section briefings, update Unit Leaders– Maintain current status of all Sections

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gPlanning Section Chief

• Supervises:– Resources Unit Leader– Situation Unit Leader– Documentation Unit Leader– Demobilization Unit Leader

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gResource Unit Leader

• Mission: – Maintain information on the status, location, and

availability of personnel, teams, facilities, supplies, and major equipment to ensure availability of use during the incident. Maintain a master list of all resources assigned to incident operations

• Oversees:– Personnel Tracking Leader– Materiel Tracking Leader

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gTracking Leaders

• Personnel Tracking Leader– Mission:

• Maintain information on the status, location, and availability of on-duty staff and volunteer personnel

• Materiel Tracking Leader– Mission:

• Maintain information on the status, location, and availability of equipment and supplies within the hospital inventory and additional materiel received from outside agencies in support of the incident

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gSituation Unit Leader

• Mission:– Collect, process, and organize ongoing situation

information; prepare situation summaries; and develop projections and forecasts of future events related to the incident. Prepare maps and gather and disseminate information and intelligence for use in the Incident Action Plan (IAP)

• Focus is on current and future situation management

• Writes and maintains situation updates and IAPs• Maintains the HCC Status Boards

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gSituation Unit Leader

• The Situation Unit is very busy!

– Staff with lots of clerical assistance

– Staff with people to monitor TV, media

– Networks closely with the Liaison Officer

• Supervises:

– Patient Tracking Leader

– Bed Tracking Leader

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gTracking Leaders

• Patient Tracking Leader:– Mission:

• Monitor and document the location of patients at all times within the hospital's patient care system, and track the destination of all patients departing the facility

• Bed Tracking Leader:– Mission:

• Maintain information on the status, location, and availability of all patient beds, including disaster cots and stretchers

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gDocumentation Unit

• Mission: – Maintain accurate and complete incident files,

including a record of the hospital’s/HCC response and recovery actions and decisions; provide duplication services to incident personnel; and file, maintain, and store incident files for legal, analytical, and historical purposes

• Duties:– Collects, organizes and archives all response and

recovery documentation and paperwork (forms)– Assists in writing the Incident Action Plan (IAP) – Assists in preparing the After-Action Report and

Corrective/Improvement Plan based on lessons learned**

– Works closely with the Situation Unit Leader

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gDemobilization Unit

• Mission:– Develop and coordinate an Incident

Demobilization Plan that includes specific instructions for all staff and resources that will require demobilization

• Duties:– Responsible for drafting demobilization and

system/business recovery plan for the incident approved by the Command Staff/Incident Commander

– Demobilization starts EARLY in the response!

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gSection Summary

• The Planning Section is responsible for:– Collecting, evaluating and disseminating incident

situation information and intelligence to the HCC– Maintaining resource status– Developing the Incident Action Plan (IAP) **– Archiving all response and recovery

documentation– Assisting with development of the After-Action

Report

• The Planning Section is led by a Chief

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gFinance/Administration

Section

Finance/AdministrationSection Chief

Procurement UnitLeader

Compensation/Claims Unit

LeaderTime Unit Leader Cost Unit Leader

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• Section Mission:– Account for costs incurred from the outset of the

response – Account for expenses from multiple cost centers – Monitor, track and report personnel, time, repair,

purchase, and replacement expenses and lost revenue

– Modify or expand daily (usual) accounting practices to meet the needs of the incident and outlined in the EOP

• Section led by a Chief

Finance/Administration Section

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gFinance/Administration

Section Chief• Mission:

– Monitor the utilization of financial assets and the accounting for financial expenditures. Supervise the documentation of expenditures and cost reimbursement activities

• Duties:– Oversee the acquisition of supplies and services

to carry out the medical mission– Supervise the documentation of expenditures

relevant to the emergency incident– Directs financial RECOVERY

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gFinance/Administration

Section Chief

• Supervises:– Time Unit Leader– Procurement Unit Leader– Compensation/Claims Unit Leader– Cost Unit Leader

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g Time Unit Leader

• Mission:– Responsible for the documentation of personnel

time records. Monitor and report on regular and overtime hours worked/volunteered

• Adjusts reports and tracking to meet the needs of the incident– Tracking of altered or expanded work periods/shifts– Developing specialized tracking forms to capture

response and recovery time

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gProcurement Unit Leader

• Mission:– Responsible for administering accounts receivable

and payable to contract and non-contract vendors

• Initiates emergency contracts • Agreements should be already in place • Confirm existing vendors can deliver in emergencies • Confirm payment arrangements

• Manages purchase orders

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gCompensation/Claims

Unit Leader • Mission:

– Responsible for receiving, investigating and documenting all claims reported to the hospital during the emergency incident, which are alleged to be the result of an accident or action on hospital property

• Duties:– Manages claims and worker’s compensation issues

• Injury/illness to staff, volunteers and visitors

• Should have comprehensive line of duty death procedure to implement if needed

• Follow up coverage/compensation/benefits clearly outlined and shared with staff member

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gCost Unit Leader

• Mission:– Responsible for providing cost analysis data for the

declared emergency incident and maintenance of accurate records of incident cost

• Duties:– Track and pay response and recovery costs – Projects lost revenue– Prepares documents for state/federal reimbursement

when applicable– Tracks payments

• Patient insurance and reimbursement• Government

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gSection Summary

• The Finance/Administration Section**– Manages costs related to the incident– Provides

• Accounting• Procurement• Time recording• Cost analysis

• The Section is led by a Chief**

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Questions?

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g Job Action Sheets

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gPurpose of the JAS

• An incident management tool to familiarize the user with critical aspects of the command position he or she is assuming.

• The series of action steps are intended to “prompt” the incident management team members to take needed actions related to their roles and responsibilities

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gUse of the JAS

• HICS provides 78 Job Action Sheets

• In most cases only a portion of these positions will be necessary for a successful response

• Activation of HICS positions may be based on:– Scope and magnitude of the event– Hospital size– Available resources– Response needs

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gJAS Format

• The key format considerations for each JAS are the same and include the following information:– Command Title – the name of the position– Mission – a brief statement summarizing the basic

purpose of the job– Fundamental Information Box –

• Date and times• Highlights reporting relationships• Records to whom the position is assigned• Location of the HCC or position• Contact information and radio title

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gJAS Format

OPERATIONS SECTION CHIEF

Mission: Develop and implement strategy and tactics to carry out the objectives established by the Incident Commander. Organize, assign, and supervise Staging, Medical Care, Infrastructure, Security, Hazardous Materials, and Business Continuity Branch resources.

Date: Start: End: Position Assigned to: Initial:

Position Reports to: Incident Commander Signature:

Hospital Command Center (HCC) Location: Telephone:

Fax: Other Contact Info: Radio Title:

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gJAS Format

• Action Steps and Considerations – JAS provides position action steps and

considerations

• Actions listed by operational periods– Immediate 0–2 hours– Intermediate 2–12 hours– Extended Beyond 12 hours– Demobilization/System Recovery (New)

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gJAS Format

• The JAS format enables users to:– Document each action undertaken with initials– Record decision and action timeframes

• Many action steps are common to all positions– Read the entire JAS– Put on position identification– Notify your usual supervisor of your HICS position– Document using forms– Coordinate with other HICS positions– Include considerations for shift change report

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gImmediate Actions – Operations Chief

Immediate (Operational Period 0-2 Hours) Time Initial

Receive appointment and briefing from the Incident Commander. Obtain packet containing Operations Section Job Action Sheets.

Read this entire Job Action Sheet and review organization chart (HICS Form 207). Put on position identification.

Notify your usual supervisor of your HICS assignment.

Determine need to appoint Staging Manager, Branch Directors, and Unit Leaders in Operations Section; distribute corresponding Job Action Sheets and position identification. Complete the Branch Assignment List (HICS Form 204).

Brief Operations Section Branch Directors and Staging Manager on current situation and incident objectives; develop response strategy and tactics; outline Section action plan and designate time for next briefing.

Participate in Incident Action Plan preparation, briefings, and meetings as needed; assist in identifying strategies; determine tactics, work assignments, and resource requirements.

Obtain information and updates regularly from Operations Section Branch Directors and Staging Manager; maintain current status of all areas; inform Situation Unit Leader of status information.

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gIntermediate Actions – Operations Chief

Intermediate (Operational Period 2-12 Hours) Time Initial

Communicate regularly with the Incident Commander, Public Information Officer and Liaison Officer; brief regularly on the status of the Operations Section.

Designate time(s) for briefings and updates with Operations Section leadership to develop or update the Section action plan.

Initiate the Resource Accounting Record (HICS Form 257) to track equipment used during the response.

Schedule planning meetings with Branch Directors and Staging Manager to update the Section action plan and demobilization procedures.

Coordinate patient care treatment standards and case definitions with public health officials, as appropriate.

Ensure that the Operations Section is adequately staffed and supplied.

Coordinate personnel needs with Labor Pool & Credentialing Unit Leader, supply and equipment needs with the Supply Unit Leader, projections and needs with the Planning Section, and financial matters with the Finance/Administration Section.

Ensure coordination with any assisting or cooperating agency.

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gExtended Actions – Operations Chief

Extended (Operational Period Beyond 12 Hours) Time Initial

Continue to monitor Operations Section personnel’s ability to meet workload demands, staff health and safety, resource needs and documentation practices.

Continue to maintain the Resource Accounting Record (HICS Form 257) to track equipment used during the response.

Conduct regular situation briefings with Operations Section Branch Directors and Staging Manager.

Address issues related to ongoing patient care: Ongoing patient arrival Bed availability Patient transfers Patient tracking Staff health and safety Mental health for patients, families, staff, incident management personnel Fatality management Staffing Staff prophylaxis Medications Medical equipment and supplies Personnel and resource movement through Staging Area Linkages with the medical community, area hospitals, and other healthcare facilities Documentation

Upon shift change, brief your replacement on the status of all ongoing operations, issues, and other relevant incident information.

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Demobilization/System Recovery Actions Operations Chief

Demobilization/System Recovery Time Initial

As needs decrease, return Operations Section staff to their usual jobs and combine or deactivate positions in a phased manner, in coordination with the Demobilization Unit Leader.

Coordinate patient care restoration to normal services.

Coordinate final reporting of patient information with external agencies through Liaison Officer and Public Information Officer.

Work with Planning and Finance/Administration Sections to complete cost data information.

Debrief staff on lessons learned and procedural/equipment changes needed.

Upon deactivation of your position, brief the Incident Commander on current problems, outstanding issues, and follow-up requirements.

Upon deactivation of your position, ensure all documentation and Operational Logs (HICS Form 214) are submitted to the Documentation Unit.

Submit comments to the Incident Commander for discussion and possible inclusion in an after-action report; topics include:

Review of pertinent position descriptions and operational checklists Recommendations for procedure changes Section accomplishments and issues

Participate in stress management and after-action debriefings. Participate in other briefings and meetings as required.

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gJAS Format

• Documents/Tools – – A listing of pertinent HICS forms this position is

responsible for using• Forms noted in JAS action steps

– Other tools that will help them fulfill their role and responsibilities

• Hospital plans, policies and procedures• Technology tools• Other adjuncts

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gDocuments/Tools –

Operations Chief

Documents/Tools

Incident Action Plan HICS Form 204 – Branch Assignment Sheet HICS Form 207 – Organization Chart HICS Form 213 – Incident Message Form HICS Form 214 – Operational Log HICS Form 257 – Resource Accounting Record Hospital emergency operations plan Hospital organization chart Hospital telephone directory Radio/satellite phone

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gRole of Deputies and Assistants

• No JAS has been written for a Deputy Chief or assistants– They work from the JAS of the position they assume

• Deputy Chief: – Assigned for Command or General Staff

• Assistant:– Assigned for Command or General Staff– Assigned to Unit Leaders as needed and resources allow

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gJAS Use

• The format allows for the JASs to be used – To preliminarily document actions taken during the

incident – To develop a chronology of events, problems

encountered, and decisions made

• Use the Operational Log (HICS Form 214) continuously to detail actions, decisions and activities

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gJAS Use

• JASs are used continuously during the response– Actions in all operational periods should be

continued and monitored

• JAS should transfer to your replacement and actions continued– Upon shift change or position change

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gJAS Customization

• The JASs are designed to be customized for the needs of each hospital

– Hospitals can use the HICS JASs as prepared– Hospitals can modify the HICS JASs based on:

• Hospital size• Available resources• Response needs

– Hospitals can craft their own, unique JAS

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gJAS Customization

• Hospitals are encouraged to use the HICS JAS model as a template for customized JASs

– Maintain the prescribed format and terminology to ensure the standardization benefit of NIMS

– Modify the Operational Period Actions and Documents/Tools section appropriately for the facility and community

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gJAS Customization Processes

• Review all HICS Job Action Sheets – Convene subject matter experts and

stakeholders from within institution to review job action sheets

– Engage persons/staff who would fill those roles in an event

– Ensure JASs meet hospital needs• Revise content as necessary with details (e.g. correct

telephone numbers, etc)

– Place own hospital logo on each JAS if desired

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gJAS Training and Exercising

• JASs should be used in trainings and exercising– Enhance familiarity of position description, mission

and actions

• Conduct focused drills with Branches and Sections to enhance understanding of the incident management team structure

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gSection Summary

• The Job Action Sheets are:– An incident management tool– A series of actions to meet the incident response– Are divided in time phases

• Immediate 0-2 hours• Intermediate – 2-12 hours• Extended – Greater than 12 hours• Demobilization/System Recovery

– Standardized to facilitate interagency response– Customizable for the unique facility needs/roles

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g Incident Action Planning

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gIncident Action Plans

• Incidents Action Plans:– Provide all IMT personnel with direction for actions based

on the objectives during the operational period**– Are a means of communicating the overall incident

objectives, including:• Operational activities• Support activities

– A tool to successful transition of operational activities to HCC relief staff

• Incident action planning requires an understanding the hospital’s policy and direction

• Incident action planning is essential for a successful response and recovery

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gIncident Action Plans

• IAP processes use Management by Objectives– Setting the Operational Period– Determining overall priorities– Establishing specific, measurable, attainable objectives– Selecting effective strategies and tactics to accomplish

objectives– Identify needed resources– Develop and issue assignments– Direct, monitor and evaluate response efforts to enhance

response in the next op period– Document results – Corrective actions

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gIncident Action Planning

• The IAP covers an Operational Period

• Elements of an IAP– What must be done– Who is responsible– How information is communicated– What should be done if someone is injured

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gIncident Action Planning Process

• The Incident Commander sets times for IAP meetings

• The Section Chiefs develop their Section’s action plan for the next operational period– Input from Branch and Unit staff

• Section IAP submitted to Planning Chief– Assimilated into a single HCC IAP– Documentation and Situation Unit Leaders

compile the IAP

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gIncident Action Planning Process

• Incident Action Planning Meeting conducted by the IC– Command Staff and General Staff attend the meeting

• IAP is discussed and modified, as needed

• Next Action Planning Meeting is determined

• IC Approved and final IAP is distributed to HCC staff– Distribution by the Documentation Unit Leader

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gIncident Action Planning

• The IAP should be developed ASAP after the HCC is operational– It becomes the preliminary guidance for a defined,

short operational period

• HICS forms to utilize:– HICS Form 201 – Incident Briefing– HICS Form 202 – Incident Objectives**– HICS Form 203 – Organizational Assignment List– HICS Form 261 – Incident Action Plan Safety Analysis

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gSection Summary

• The IAP provides all IMT personnel with direction for actions based on the objectives during the operational period**

• Incident Action Planning uses the elements of Management by Objectives

• Incident Action Planning is done by Command and General Staff

• Incident Action Planning is essential for effective response and recovery

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Questions?

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Incident Planning Guides &

Incident Response Guides

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gIncident Specific Planning

• During the initial response period, activities are guided by:– Emergency Operations Plan– Incident-specific guides

• These plans/guides assist the IC:– To conduct a situation assessment– Set initial objectives– Establish the HCC/ICS organization

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gHICS IPGs and IRGs

• An incident-specific scenario “sets the stage” for the IPGs and IRGs

• 13 internal scenarios– Based on most likely internal hospital incidents

• 14 external scenarios– Based on the Department of Homeland Security

National Planning Scenarios

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Internal Guides• Bomb Threat• Evacuation• Fire• HazMat Spill• Hospital Overload• Hostage/Barricade• Infant/child abduction• Internal flooding• Loss of HVAC• Loss of Power• Loss of Water• Severe weather• Work stoppage

All-Hazards Guide

External Guides• Nuclear Detonation

• Biological attack - Anthrax

• Biological disease outbreak -Pandemic Influenza

• Biological Attack – Plague

• Chemical Attack – Blister Agent

• Chemical Attack – Toxic Industrial Chemicals

• Chemical Attack - Nerve agent

• Chemical Attack – Chlorine

• Natural Disaster – Earthquake

• Natural Disaster – Hurricane

• Radiological Attack – RDD

• Explosives Attack – IED

• Biological Attack – Food Contamination

• Cyber Attack

Incident Planning and Response Guides

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gIntroductory Scenario

Example: Internal Scenario - Fire

Your hospital is in the middle of the annual flu season. It is mid winter and it is unusually cold outside. The time is 10:30 PM. The hospital inpatient beds are at 95% capacity and there are patients holding in the ED to be admitted.

A fire has broken out and has engulfed the laboratory area, and the fire sprinkler system in that area has activated. The fire department quickly responds and extinguishes the fire before it can spread beyond the laboratory area. The fire department assists with the smoke and water removal.

Two staff members from the laboratory are injured with burns and smoke inhalation, one seriously and one in critical condition. The lab is totally destroyed and is unusable. The extensive smoke and water damage has spread to the ICU and the patient rooms above the lab. The staff are asking if they should evacuate the hospital. The local press is now on scene and is demanding information and access to the hospital.

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gIPGs and IRGs

• Hospitals use these incident-specific guides– According to the facility HVA – The community HVA

• Additional IRGs and IPGs may need to be developed by the facility to address a hazard

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Incident

Planning Guides

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gIncident Planning Guides

• Incident Planning Guides– Outline strategic planning considerations for

incident-specific situations– Formatted to the emergency management

phases• Mitigation (including prevention)• Preparedness• Response• Recovery

– Used to evaluate the facility’s Emergency Operations Plan

– Used to develop Incident Response Guides

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gIPG: Example - Fire

Does your Emergency Management Plan Address the following issues?

Mitigation & Preparedness

Does the fire alarm and overhead announcement sound loudly enough to be heard in all locations?

Does the fire alarm system include both audible and visual systems (e.g. alarm tone and flashing strobe lights)?

Does the hospital have lighted emergency exits in all areas?

Does the fire alarm automatically notify the local fire department?

Does the hospital have a fire plan that includes closing and securing all doors and windows?

Does the hospital have procedures to immediately shut off valves that control oxygen and other gases?

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Incident

Response

Guides

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gIncident Response Guides

• Incident Response Guides– Are incident-specific– Are activated during response– Provide critical considerations and actions for the

Command and General Staff– Are time based:

• Immediate – 0-2 hours• Intermediate – 2-12 hours• Extended – Greater than 12 hours• Demobilization/System Recovery

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gIncident Response Guides

• Should complement– Emergency Operations Plan

• They complement the EOP but not replace the EOP

– Job Action Sheets

• Can be used as initial documentation

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gIRG – Example: Fire

Mission: To reduce the loss of life and property during an internal fire incident.

Directions

□Read this entire response guide and review incident management team chart

□Use this response guide as a checklist to ensure all tasks are addressed and completed

Objectives□ Confine the fire/reduce the spread of the fire□ Rescue and protect patients and staff□ Implement internal emergency management plan – fire

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gIRG – Example: Fire

Immediate Actions (Operational Period 0-2 Hours)

□

COMMAND (Incident Commander): -- Activate the facility emergency operations plan and the Incident

Command structure-- Appoint Command Staff and Section Chiefs-- Consider the formation of a unified command with hospital and fire

officials -- Determine need for and type of evacuation(PIO): -- Establish a media staging area-- Conduct regular media briefings to update situation status and

provide appropriate patient and employee information-- Oversee patient family notifications of incident and

evacuation/relocation, if ordered

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gIRGs and IPGs

• Uses of the Guides– To evaluate the EOP– A training tool– Tabletop exercises– As a planning basis for a functional exercise

• Guides will promote more immediate and higher quality decision-making

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gJAS versus IRGs & IPGs

• The IRGs are not intended to be a replacement for Job Action Sheets– IRGs

• Overview position actions and decision making• Are Incident Specific

– JASs• Detail position actions, decisions and activities• Are all-hazards focused

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gSection Summary

• IPGs and IRGs– Are incident-specific tools to assist hospitals with

planning, training and response/recovery efforts– Assist in meeting regulatory requirements– Guide Command and General Staff with decision-

making and action-taking– Should be consistent with the EOP– Do not replace the JAS

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Questions?

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HICS Forms

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gUsing the HICS Forms

• Purpose:– To provide the incident management team with the

documents needed to manage a response

• Use:– Each form has a specific purpose identified at the

bottom of the form– Instruction sheets for each form can be printed on

reverse side of each form, if desired

• Forms have been modified from existing FEMA ICS forms for use in hospitals

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gValue of Using HICS Forms

• Your facility will be consistent with other healthcare facilities and community responders

• Information can be more easily shared among all responders

• Documentation guides your response and assists in your recovery efforts

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gValue of Using HICS Forms

• Serves as a road map in response: everyone acting from the same plan

• Serves as a foundation for corrective action

• Ensures consistency and compliance with regulatory guidelines

• Complies with NIMS Publications Management Standard*

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gUsing the HICS Forms

• Forms format includes:– Form number– Name of form– Who is responsible for completion– When form is to be completed

• 20 HICS forms – Found in the Guidebook Appendix D

• Utilize current facility forms + HICS forms for response

• Develop additional forms to meet the incidents

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gUsing HICS Forms

• Appropriate HICS forms completed by each HCC position– Forms can be done electronically or hand-written– Write legibly and clearly– Complete all areas on the form

• Completed forms distributed with a copy to the Planning Section– Forms will be archived to document response

• Forms and other incident documentation used to craft the AAR

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No. Name Responsible201 Incident Briefing Incident Commander

202 Incident Objectives Section Chiefs

203 Organizational Assignment List Resource Unit Leader

204 Branch Assignment List Branch Directors

205 Communications Log Communications Unit Leader

206 Staff Medical Plan Support Branch Director

207 Organization Chart Incident Commander

213 Incident Message Form All Positions

214 Operational Log Command Staff and General Staff

251 Facility System Status Report Infrastructure Branch Director

HICS Forms

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gNo. Name Responsible

252 Section Personnel Time Sheet Section Chiefs

253 Volunteer Staff Registration Labor Pool & Credentailiting Unit Leader

254 Disaster Victim / Pt Tracking Form Patient Tracking Manager

255 Master Pt Evacuation Tracking Form Patient Tracking Manager

256 Procurement Summary Report Procurement Unit Leader

257 Resource Accounting Record Section Chiefs

258 Hospital Resource Directory Resource Unit Leader

259 Hospital Casualty / Fatality Report Patient Tracking Manager

260 Patient Evacuation Tracking Form Inpt Unit Leader Outpt Unit Leader, Casualty Care Unit Leader

261 Incident Action Plan Safety Analysis Safety Officer

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gHICS 201 – Incident Briefing

• Purpose– Documents initial response information and actions taken at start-up

• Origination– Incident Commander

• Copies to– Command staff, Section Chiefs, and Documentation Unit Leader

• When to Complete– Prior to briefing the current operational period

• Helpful Tips– Distribute to all staff before initial briefing

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gHICS 201 – Incident Briefing

• Instructions– Print legibly and enter complete information

• Incident Name• Date of briefing• Time of Briefing• Event History and Current Actions Taken• Current Organization• Notes (warnings, directives, etc.)• Prepared by (name and position)• Facility Name

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gLab/West Wing Fire 2-27-06 0800

Fire broke out at 7:00 am in the main laboratory on the 2nd floor. Large amount of smoke with foul odor. Fire sprinklers activated.

0800 Fire department arrived and unified command established.

0705 HCC activated. EOP activated. Fire department enroute. Positions activated: Safety Officer, Operations Chief, Infrastructure Branch Director and Medical Care Branch Director

Evacuation of patient care areas near the lab in progress. All depts instructed to send casualty reports to HCC.

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gJ. Smith

B. Walters L. Henson

A. Doe

C. Barton N. DeGuzman R. O’Reilly A. Greenspan

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gHICS 202 – Incident Objectives

• Purpose– Defines objectives and issues for operational period

• Origination– Planning Section Chief

• Copies to– Command staff, General Staff and Documentation Unit

Leader

• When to Complete– Prior to briefing the current operational period

• Helpful Tips– Serves as a roadmap to incident management

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gHICS 202 – Incident Objectives

• Instructions– Print legibly and enter complete information

• Incident Name• Date prepared• Time prepared• Operational Period Date and Time• General Command and Control Objectives for the

Incident• Weather / Environmental Implications for the Period• General Safety / Safety Messages• Attachments• Prepared by (Planning Chief: use proper name)• Approved by (Incident Commander) • Facility Name

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g

Lab/West Wing Fire

2-27-07 0800 2-27-07 0800 - 1500

Winds from NE at 12 mph. Low fog remains, expected to dissipate by 1100. Temperatures currently 41 degrees; high of 55 expected with overnight temps to high 30’s. Rain forecast by weekend.

1. Ensure communications links to Fire Department, community hospitals and emergency operations center are functioning

4. Establish alternate care sites as needed for patient evacuations

3. Assess injuries to patients, visitors and staff

2. Initiate structural assessment of hospital

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HICS 203: Organization Assignment List

J SmithBarbara Walters

Lab/West Wing Fire

2-27-07 0900 0800-1500

L. HensonJane Doe

Clara Barton

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gHICS 203: Organization Assignment List

Radar O’Reilly

John Q. Public

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gHICS Form 204: Branch Assignment List

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gHICS Form 204: Branch Assignment List

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gHICS Form 213: Incident Message Form

Call from the laboratory manager. States that the lab will not be functional due to major equipment damage from heat and smoke. Laboratory non-functional. Request transportation of stat lab specimens to the community laboratory for testing.

2-27-07 1000

R. O’Reilly, LogisticsC Barton, Operations

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gHICS Form 213: Incident Message Form

Community Laboratory called and will accept specimens and blood tubes for testing. Transporation van will pick up specimens and transport to the community lab at 1200.

IMA Vampire 1100

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HICS Form 214

2-27-07 0800-15002-27-07

Lab/West Wing Fire

Operations, Medical Care Branch0820 Position Activated and situation briefing obtained

West Unit patient care unit with major smoke damage. Patients with respiratory symptoms and anxiety. Ordered evacuation of the wing

0900

Clara Barton

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HICS Form 254

Lab/West Wing Fire

2-27-07 2-27-07 0800-1500

2135 Brad Pitt M 34 ED 1200 1230Transfer

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gHICS Form 255

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HICS Form 257

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gHICS Form 258

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gHICS Form 258

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HICS Form 258

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HICS Form 261

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gSection Summary

• The HICS forms:– Provide the Incident Management Team with the

documents needed to manage a response– Assist in communication with external agencies

and resources – Assist in communication with hospital staff – Provide documentation for response and

recovery activities

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Questions?

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gExternal Agency Coordination

• Hospitals can no longer plan for emergencies in a silo– Effective preparedness and response requires

integration with other community responders– Include local, regional and state responders– Joint Commission requires community-wide planning

and collaboration with responders

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gExternal Agency Coordination

• Hospitals should be actively engaged in community planning and preparedness– Public Safety

• Law enforcement/Medical Examiner or Coroner• Fire• EMS

– Public health– Emergency Management (local agency)– Behavioral/Mental Health– Other public and private agencies

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gCommunity Planning

• Meetings with response partners serve to:– Increase understanding of response roles and

limitations– Develop regional response plans and procedures– Plan, conduct and evaluate collaborative exercises– Conduct multi-disciplinary training– Build personal relationships across disciplines for

better communication and response

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gHospital Collaboration

• Hospitals must also plan and prepare with other healthcare partners– Within the corporate healthcare system– Other community hospitals– Clinics– Long-term care facilities– Regional Hospital Coordination Centers– Regional Hospital Associations

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gHospital Collaboration

• Hospitals in a community should meet regularly– Cooperative planning and training– Conduct joint exercises

• Standardization between hospitals– Terminology– Use of HICS– Mutual aid and scarce resource sharing– Integrated plans and procedures

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gHospital Collaboration

• Develop and sign mutual aid agreements or MOUs– How to request assistance from sister hospitals– Sharing of resources

• Hospital resources• Community resources

– Credentialing of staff/volunteers– Initiation of patient transfers– Standardizing purchases of equipment and

supplies (cost savings and increased capacity)

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gHospital Collaboration

• Achieving the hospital collaboration points will meet four NIMS elements– Element 1: Organizational adoption of NIMS– Element 2: Utilization of ICS– Element 3: Multi-agency coordination systems– Element 17: Standardized and consistent

terminology

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gHealthcare Provider Collaboration

• Hospital collaboration with non-hospital facilities– Clinics– Urgent Care Centers and MD offices– Long-term care facilities

• Include these providers in planning, training and exercises– They can provide valuable resources – Can augment healthcare capacity and preserve

acute care hospitals for acute care

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gHospital Command Center Activation

• Once the HCC is activated– Communication and information sharing with

partners is vital– Liaison Officer is the formal line of communications

into and out from the facility• But some positions also have communication and

coordination lines with community providers and responders….

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g

Incident Commander

Hospital CEO

(if not IC)

Hospital Corporation or System

EOC/Operations

Individual Hospital Board of Directors

Safety Officer

Medical/Technical Specialists

Liaison Officer

Public Information

Officer

Other Hospitals

Other Hospitals

Other Hospitals

IntrastateRegional

Emergency Operations

Center

State Emergency Operations

Center

Local EOC JIC

Regional/State EOC

JIC

Regional Hospital

Coordinating Center PIO or

JIC

Other Hospital

PIOs

Federal Emergency Operations

Centers

LegendCEO – Chief Operating Officer

EOC – Emergency Operations Center ESF – Emergency Support Function

IC -- Incident CommanderJIC – Joint Information Center

MMRS – Metropolitan Medical Response SystemMRC – Medical Reserve Corp

PIO -- Public Information Officer

Local and Community

Public Safety Agencies

Individual Hospital Command Center

Regional Hospital

Coordinating Center

Local EOC, Health and Medical Services Branch, ESF # 8 or other public

agency/community resources (i.e., MMRS, MRC, etc.), and

Multiagency Coordination

Inter-State Emergency Operations

Center

HICS Guidebook, Chapter 4, Page 21

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gHICS and Unified Command

• Single agency command **– One agency involved in the response– Hospitals using HICS are single agency command

structures

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gHICS and Unified Command

• Unified command is instituted **– When more than one responding agency is present

or,– The situation crosses political jurisdictions– Leaders from the agency are co-located for

collaborative decision making– A unified IAP is developed– Unified command may occur when hospitals are

asked to respond to the incident scene

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gHICS and Unified Command

• When does unified command apply to hospitals?– When the hospital is the scene of the incident and

other responders come to the facility– Example:

• Hostage situation – Law Enforcement• Hospital Fire – Fire• Bomb threat –Bomb Squad/Law Enforcement• Building collapse – Fire and Search & Rescue• Water outage/rupture – Public Works

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gHICS and Unified Command

• Unified command in the HCC– A Unified Incident Management Team (UIMT) would be

formed in the HCC• Bomb Threat--- Hospital IC and Law Enforcement IC

• The UIMT facilitates– Information sharing– Individual agencies provide input into IAP

• Each agency retains individual authority over its assets and responsibilities

• Although there is equality, there still is a final authority– In our example– who would that be?

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gHICS and Area Command

• Area command is defined as:– A command structure to oversee the

management of large or multiple incidents with individual ICS structures

• The area command structure– Sets overall strategies and priorities– Allocates critical resources– Ensure incidents are properly managed– Ensures overall objectives are achieved

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gHICS and Area Command

• Hospital example:– A large healthcare organization with multiple

buildings on the facility grounds• Main hospital• Women’s hospital• Multiple clinics

– A tornado occurs with scattered areas of activity and damage to multiple facilities

• All buildings activate their incident command structures/HCC

– The Main hospital serves as area command for all facilities, but each facility maintains an ICS structure

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gSection Summary

• Hospitals must plan collaboratively with community responders for effective emergency response and recovery

• Establishing and rehearsing pre-event MOUs or mutual aid agreements will ensure effective response

• Hospitals may utilize unified command and area command structures in certain situations

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g

Questions?

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HICS for

Small and Rural

Facilities

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gRural and Small Hospital Challenges

• Preparedness apathy:– “It can’t happen here!”

• Relative isolation:– Geography/distance may isolate the facility– Remote distance from resources may delay

assistance

• Limited resources and surge capacity:– Fewer resources in the hospital and community– Local government resources limited– Limited reliable and redundant communications

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gSmall and Rural Hospital Challenges

• Limited healthcare personnel resources– Overlapping community roles

• Healthcare providers serving on EMS units

– Reliance on community volunteers

• Limited funding– Government grants based on population – Population bases do not account for “seasonal”

surge (i.e., vacation time, concerts, large events)

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gSmall and Rural Hospital Challenges

• Rural areas may be the destination for urban residents during an incident!– Large numbers will quickly overwhelm resources

• National guidelines and recommendations– Mostly focus on urban and suburban regions– Do not account for variances in rural communities

• Yet, rural and small hospitals must meet all standards or recommendations!

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g

Using HICS in Using HICS in

Smaller and Rural Hospitals!Smaller and Rural Hospitals!

It Can Be Done!It Can Be Done!

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gIncident Commander

Planning Section Chief

LogisticsSection Chief

Operations Section Chief

Finance/

Administration Section Chief

Liaison Officer

Medical/Technical Specialist

Safety Officer

Public Information Officer

Procurement Unit Leader

Compensation/Claims

Unit Leader

Time Unit Leader

Cost Unit Leader

Service Branch Director

Support Branch Director

Resources Unit Leader

Situation Unit Leader

Documentation Unit Leader

Demobilization Unit Leader

Staging

Manager

Medical Care Branch Director

Infrastructure Branch Director

HazMat Branch Director

Security Branch Director

Business Continuity

Branch Director

Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit

Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit

Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit

Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit

Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit

Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging Team

Personnel TrackingMateriel Tracking

Patient TrackingBed Tracking

Communications UnitIT/IS UnitStaff Food & Water Unit

Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit

Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist

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gHICS for Smaller Facilities

• Adapt HICS to your facility– Consolidate positions

• Maintain the basic command structure

Incident Commander

Safety Officer

Finance/Administration Section Chief

Liaison Officer

PIO

Planning Section Chief

Operations Section Chief

Logistics Section Chief

Medical/Technical Specialists

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gHICS for Smaller Facilities

• Adapt HICS to your facility– Combine the duties of like positions under the

Branches• Condense the JAS with critical duties for like positions

listed• Concentrate on the main Sections and Branches or critical

Unit Leaders

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gExample Adapted IMT

Incident Commander

Safety Officer

Finance/Administration Section Chief)

(Time, Procurement, Claims/Compensation

and Cost)Medical Care

Branch Director

Infrastructure Branch Director (except Building/Grounds & Food

Services Unit)

Liaison Officer

PIO

Planning Section Chief including Demobilization

Documentation Unit Leader

Resource/Situation Unit Leader

Operations Section Chief

Support Branch Director

Logistics Section Chief

Service Branch Director (includes

Communications, IT/IS)

Staff AND Patient Food and Water

Business Continuity Branch

Director

Security Branch Director

HazMat Branch Director

Employee Health and Well-Being, Family Care

Unit Leaders

Labor Pool and Credentialing Unit &

Transportation Unit and Personnel Staging

Manager

Supply & Facilities Unit Plus Buildings and

Grounds Unit

Medical/Technical Specialists

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gHICS For Smaller Facilities

• When adapting the IMT and consolidating positions,– Create JASs for each position – Include critical actions

• In mission statement• In JAS elements

• Suggest having the full IMT JAS available– If a large incident and help arrives

• Each position can then be activated

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gSection Summary

• The HICS IMT can be adapted for smaller and rural facilities

• JASs can be created for consolidated positions– Maintaining mission statements and title

• Remember, you only activate positions as needed to meet the incident

• Keep all HICS JAS in the event positions need to be expanded

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Questions?

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gSummary of the Day

• Today we have learned about:– NIMS and ICS concepts and principles– NIMS Implementation Activities for Hospitals– The origins of HICS– The Hospital Incident Command System

• Incident Management Team• Command and General Staff• All HICS positions

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gSummary of the Day

• Today we learned about:– The importance of Incident Action Planning – HICS Materials

• Job Action Sheets• Incident Planning and Response Guides• Forms• The importance of Incident Action Planning

– Relationship of the Hospital to Community Responders– HICS for Rural and Small Hospitals

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gEvaluation of the Day

How was the course

so far????

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