Healthcare Facilities Incident Command(Principles)

Presented By:

Mohammad-Reza Khaje-Aminian

PhD Student of Health in Disasters & Emergencies

Tehran University of Medical SciencesSchool of Public Health

Department of Disaster Public Health

Ministry of Health & Medical EducationNational Institute of Health Research

Department of Disaster & Emergency Health

Shahid Sadoughi University of Medical SciencesAllied Medical School

PreHospital Emergency Care Department

Introduction

D u r i n g a D i s a s t e rPreparedness and Organization of a healthcare facility

Required to

Maximize the utilization of the available resources

To Provide

The highest achievable level of care for the community

The highest achievable level of care for the community require to:

Development of an Emergency Management Program (EMP) aimed at:

1) Protecting the facility and its people (patients and staff)

2) Responding to the community’s increased healthcare needs

3) Continuing to provide healthcare services

4) Assuring the safety of all involved

HealthCare's Facility Management(Normal Condition Vs. Disaster)

Normal Condition:

Functioning and managing healthcare utilizing consensus decision-making based on extensive data

Disaster:

Requires that time-sensitive decisions be made with imperfect information

Command Structure

Controlling the situation not only requires planning, it requires the delineation of alternate roles and responsibilities of hospital staff in an organized management system

Central to this organization is a command structure that details the roles and responsibilities of those involved in leading the healthcare facility through all phases of a disaster

Focus of ICS

Incident management focuses on Command

Control

Coordination

Through a responsibility-oriented chain of command

Coordinati

on

Control

Command

Roles and responsibilities in ICS

To ensure understanding of the Scope of The Assignment

To ensure understanding of the Chain of Command

Roles and responsibilities in ICS Should Clearly defined

Rehearsed in drills

These roles should be created from the hospital’s Emergency Operations Plan (EOP), which details

Who is in charge

Which implementation strategy for the appropriate ICS should be installed

THE INCIDENT COMMAND SYSTEM

Definition:

ICS is an “all-hazard” approach to incident management that is driven by responsibility/position rather than by person

ICS is a flexible organizational structure capable of shrinking and expanding based on the size and complexity of the event

History of ICS

The foundation for the current ICS was developed in the 1970s by an interagency task force of local, state, and federal personnel

Initially, the system was designed to coordinate fire personnel combating large-scale responses, and was developed to correct the myriad of response-related problems that repeatedly were found by the task force analyses of prior major incidents

These problems included:

o Inadequate communication

(conflicting terminology or inefficient or improper use of technology)

o Lack of a standardized management structure

(Doesn’t allow integration, command and control, and workload efficiency)

o Lack of personnel accountability

o Lack of a systematic planning process

ICS design is meant to:

o Manage all routine, planned events or emergencies, of any size or type, by establishing a clear chain of command

o Allow personnel from different agencies or departments to be integrated into a common structure to effectively address issues and delegate responsibilities

o Provide needed logistical and administrative support to operational personnel

o Ensure key command functions are assigned, and eliminate duplication

Please attend!!!

T h e I C S d e s i g n d i ff e r s f r o m

T h a t u s e d i n t h e d a i l y a d m i n i s t r a t i v e s t r u c t u r e o f t h e a g e n c y o r h e a l t h c a r e f a c i l i t y

I f t h e u s u a l a d m i n i s t r a t i v e s t r u c t u r e a n d r e s p o n s e p r a c t i c e s a l l o w a d e q u a t e m a n a g e m e n t o f t h e p r o b l e m

T h e n a n e m e r g e n c y r e s p o n s e i s n o t w a r r a n t e d , a n d a n I C S i s n o t r e q u i r e d t o b e a c t i v a t e d

ICS Positions

ICS Positions

The ICS utilizes standard, functional positions within its organizational structure

Not all positions are required for every response

Only those positions that have functions necessary in the current situation are activated

But disaster manager must be a designated person in charge of each function that becomes operational

The use of the standardized position titles in the ICS structure serves three essential purposes

o Reduces confusion within a hospital, or with outside agencies, or other healthcare facilities, by providing a common name for all users

o Allows the position to be filled with the most qualified individual rather than by seniority

o Facilitates requests for qualified personnel, especially personnel from outside of the hospital

The Incident Commander

Person in charge of the mission

The only position that always is activated for an incident

(regardless of its nature)

The Incident Commandero Defines the mission

o Sets all response objectives

o Devises strategies and priorities

o Maintains overall responsibility for managing the incident

o Ensures its completion

The Incident Commander may choose to activate the following Command Staff positions:

o A P u b l i c I n f o r m a t i o n O ffi c e r Coordinate information sharing with internal personnel and the media

o A S a f e t y O ffi c e r Monitor operations from a safety perspective and assure the safety of all assigned personnel

o A L i a i s o n O ffi c e r Serve as the primary contact for external agencies working with the hospital and to coordinate assistance requests to the Local Emergency Operations Center (LEOC)

In select situations, the Liaison Officer may be assigned to represent the hospital at the LEOC or at the field Incident Command Post (ICP)

Commander, Command Staff and ???

In addition to the Commander and the Command Staff, there are four Sections that comprise specific management functions within an ICS; each is under the direction of an assigned chief who reports to the Incident Commander

These positions consist of the:o O p e r a t i o n s S e c t i o n C h i e f

o P l a n n i n g S e c t i o n C h i e f

o L o g i s t i c s S e c t i o n C h i e f

o F i n a n c e / A d m i n i s t r a t i o n S e c t i o n C h i e f

Each of these four primary management sections may be subdivided to meet the management demands of the incident

Operations Section Chief

o Responsible for directing all tactical operations (e.g., patient care and facility operations)

o Required to carry out the IAP by using the defined response objectives and by directing all needed resources

Planning Section Chief

Responsible for collecting and evaluating information for o Decision support

o Maintaining resource status information

o Preparing documents (such as the IAP)

o Maintaining documentation for incident reports

Logistics Section Chief

Responsible for providing o Support

o Resources

o Other Services Essential

For meeting the response objectives set by the Incident Commander

Finance/Administration Section Chief

Responsible for monitoring all costs related to the incident while providing

o Accounting

o Procurement

o Time recording

o Cost analyses

To maximize Financial Recovery & Reduce Liability

ICS Components

ICS Component

In addition to the Incident Commander, his/her four assistant Command Staff, and the four major functional sections, the ICS may be further divided into organizational components with a distinct title given to those in charge

o Divisions

o Groups

o Branches

o Units

o Single Resources

Divisions

o Used to divide an incident or facility geographically (e.g., first floor)

o This command function typically is used among non-hospital response agencies, such as fire and law enforcement authorities

o Each Division is led by a Supervisor

Groups

o Established to divide the incident management structure into functional areas of operation

o They are composed of resources that have been assembled to perform a special function (not necessarily within a single geographical division)

o Each Group is led by a Supervisor

Branches

o Created when the number of Divisions or Groups exceeds the recommended span of control (e.g., Medical Care Branch and Service Branch)

o Each Branch is led by a Director

Units

o Organizational elements that have functional responsibility for a specific Planning, Operations, Logistics, or Finance/Administration activity (e.g., Inpatient Unit, Situation Unit and Supply Unit)

o Each Unit is led by a Unit Leader

Single resources

Individual(s) or a piece of equipment with its personnel complement (e.g., perfusionist) or a crew or team of individuals with an identified Supervisor

a Task Force

a Strike Team

a Task Force and a Strike Team

The government, the police department, and the fire department may use two other organizational levels not routinely used in the hospital setting

o A Task Force

o A Strike Team

A Task Force

A combination of mixed resources (e.g., an ICU staff of nurses, technicians, and station/unit secretaries) with a common communication capability that is led by a Taskforce Leader

A Strike Team

A set number of similar resources (e.g., burn nurses) with a common communication capability who operate under the command of a Strike Team Leader

Either a Strike Team or Task Force may be sent to assist a healthcare facility that requests personnel with specific expertise during an

emergency

Span of Control(1:3–7)

o Individuals in charge can delegate authority to others when necessary, through a chain of command

o This allows an effective span of control to be maintained to ensure safety and accountability

o The recommended practice for the delegation of authority is to limit personnel management to a ratio of one supervisor to three-to-seven (1:3–7) reporting elements

Unified Command Vs.Unity of Command

Incident Commander

Operation Planning Logistic Finance

PIO Safety

Liaison