Incident Management

CHAPTERCHAPTER

Management of EMS

Incident

Management

14

Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Learning Objectives

14.1 Apply the National Incident Management System to a mass casualty incident.

14.2 Describe the major components of an incident management system.

14.3 Describe the functions of the incident commander at all EMS incidents.


Learning Objectives (Cont.)

14.4 Describe the Federal typing of the EMS resources.

14.5 Identify the component of an EMS strike team and EMS task force.

14.6 Map the Federal requirement and resources for NIMS training and EMS.


Learning Objectives (Cont.)

14.7 Apply incident management concepts to EMS incidents.

14.8 Develop an incident management system for an EMS incident.


Background

• Homeland Security Presidential Directive-5 (HSPD-5)– President Bush called on the secretary of

the Department of Homeland Security to develop a national incident management system to provide a consistent nationwide approach for federal, state, tribal, and local governments to work together to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity


Background (Cont.)

• NIMS represents a core set of doctrines, principles, terminology, and organizational processes to enable effective, efficient, and collaborative incident management at all levels

• To provide the framework for interoperability and compatibility, the NIMS is based on a balance between flexibility and standardization


Background (Cont.)

• Recent report of the “9/11 Commission” recommends national adoption of the ICS to enhance command, control, and communications capabilities


The History of Incident Command System

• The concept of ICS was developed more than 30 years ago, in the aftermath of a devastating wildfire in California – During 13 days in 1970, 16 lives were lost,

700 structures were destroyed, and more than one-half million acres burned

– The overall cost and loss associated with these fires totaled $18 million per day


The History of Incident Command System (Cont.)

• Congress mandated that the U.S. Forest Service design a system that would "make a quantum jump in the capabilities of Southern California wildland fire protection agencies to effectively coordinate interagency action and to allocate suppression resources in dynamic, multiple-fire situations."


The History of Incident Command System (Cont.)

• The California Department of Forestry and Fire Protection; the Governor's Office of Emergency Services; the Los Angeles, Ventura, and Santa Barbara County Fire Departments; and the Los Angeles City Fire Department joined with the U.S. Forest Service to develop the system – FIRESCOPE (Firefighting Resources of

California Organized for Potential Emergencies)


FIRESCOPE ICS

• Primarily a command-and-control system delineating job responsibilities and organizational structure for the purpose of managing day-to-day operations for all types of emergency incidents

• Agencies had formally agreed upon - ICS common terminology and procedures and conducted limited field testing of ICS


Variations on the Theme

• In the early 1970s, the Phoenix Fire Department developed the Fire Ground Command System (FGC)

• The concepts of FGC were similar to FIRESCOPE ICS but there were differences in terminology and in organizational structure


Variations on the Theme (Cont.)

• The FGC system was developed for structural firefighting and was designed for operations of 25 or fewer companies.

• Recognizing the continuing challenges occurring in the fire service in applying a common approach to incident command, the National Fire Service Incident Management System (IMS) Consortium was created in 1990


Variations on the Theme (Cont.)

• Its purpose was to evaluate an approach to developing a single command system


National Incident Management System

• The NIMS provides a consistent, flexible, and adjustable national framework within which government and private entities at all levels can work together to manage domestic incidents, regardless of their cause, size, location, or complexity


National Incident Management System (Cont.)

• This flexibility applies across all phases of incident management: prevention, preparedness, response, recovery and mitigation

• NIMS provides a set of standardized organizational structures– ICS, Multi-agency coordination systems

and public-information systems


National Incident Management System (Cont.)

• NIMS provides a set of standardized organizational structures– Requirements for processes, procedures,

and systems to improve interoperability among jurisdictions and disciplines in various areas

– There are six components of the NIMS


Types of Command Teams

• Type 5: Local Village and Township Level– Consists of emergency-response providers

from a small-to-medium-sized municipality or a group of smaller jurisdictions that are part of a mutual-aid agreement


Types of Command Teams (Cont.)

• Type 4: City, County, or Fire-District Level – Consists of emergency-response personnel

from a larger and generally more-populated area, typically within a single jurisdiction; this level of IMT may be developed within a larger city or county departments, or fire districts



• Type 3: State or Metropolitan-Area Level – Consists of personnel from different

departments, organizations, or agencies within a state or metropolitan region who have trained together to function as a team



• Type 2: National and State Level – Consists of federally or state-certified

personnel; have less staffing and experience than a Type I IMT, and are typically used on smaller-scale national or state incidents. Type 2 IMTs are currently in existence, and operate through the U.S. Forest Service



• Type 1: National and State Level– Consists of federally or state-certified

personnel; are the most robust IMTs with the most experience; are fully equipped and self-contained

– Type 1 IMTs are now in existence, and operate through the U.S. Forest Service


Elements of an Effective Incident Management System

• To be effective, an incident management system must be suitable for use regardless of the type of jurisdiction or agency involvement

• These may include single jurisdiction/ single agency, single jurisdiction/multi-agency, and multi-jurisdictional/ multi-agency involvement


Elements of an Effective Incident Management System (Cont.)

• The organizational structure must be adaptable to any incident or event, applicable and acceptable to users throughout a community or region, readily adaptable to new technology, and capable of logical expansion from the initial response to the complexities of a major emergency


Elements of an Effective Incident Management System (Cont.)

• Common elements in organization, terminology, and procedures are necessary for maximum application of a system and use of existing qualifications and standards

• They ensure the ability to move resources committed to the incident quickly and effectively with the least disruption to existing systems


Business Management Techniques Applied to Incident Management

• Tasks that business managers and leaders perform include planning, directing, organizing, coordinating, communicating, delegating, and evaluating

• The responsibilities of the Incident Commander (IC) include gathering and evaluating information relative to preplanning and size-up, as well as development and communication of plans



(Cont.)• The IC must be involved with directing

available resources to accomplish incident goals through operational and command responsibilities

• To ensure proper incident management by coordination of overall operations of command, tactical operations, and support functions, a responsive organization must be developed



(Cont.)

• The IC must be able to communicate effectively within the organization and assess feedback from an entire incident

• The use of terms that are understood by all resources is critical to the IC’s ability to manage the incident



(Cont.)

• Gathering and assigning resources functionally and geographically are also included in the IC's responsibilities

• Overall effectiveness of the incident action plan (IAP) must be evaluated continually, based on the results of previous operational decisions



(Cont.)• Using these data, the IC modifies the

action plan; although the IC may delegate functional authority, he or she always retains ultimate responsibility for the incident

• If the IC chooses not to delegate authority for one or more functions, he or she must perform the functions as required by the incident


Factors that Affect Incident Management

• Incident management is carried out in a constantly changing environment

• Although the situation may get better or worse, it seldom stays the same

• The dynamics of a constantly changing environment present additional challenges to the IC


Factors that Affect Incident Management (Cont.)

• Effectiveness of the incident action plan depends on factors that may be difficult to assess or confirm



• Danger increases due to the presence of hazardous contents within the involved buildings or vehicles

• Dynamics of the incident may create difficulty in gathering accurate and current information, especially because of the limited time available at an incident scene



• Additionally, emergency personnel reporting to the IC may not be able to judge the total picture.

• Compromised responder safety, poor management of resources, or the inability to expand the command organization to meet the demands of the incident may have a negative effect on public perceptions about the department



• Departments should be ready for any type of incident

• Preparation to handle every incident, with available resources regardless of size or complexity, is needed



• Emergency response personnel must consider the physical environment, command structure, and proper ICS procedures during preplanning

• Incident outcomes may be forecast by thinking ahead about the situation while preplanning, as well as during an incident

• At major incidents, a planning section is instituted to conduct this forecasting



• The complexity of an incident complicates overall incident management

• Command activities include strategic goal-setting, developing and implementing action plans, controlling/ coordinating incident operations, using all available resources, considering safety in decision-making, providing logistical support, and evaluating the action plan



• IC also is responsible for managing or delegating medical treatment, liaison with other agencies, safety of personnel, and media requests

• Multiple priorities of life safety, incident stabilization, and property conservation must be maintained, often with limited resources



• Property conservation considerations include impacts on structures and the environment

• Hazardous-materials incidents requiring major evacuation, wildland fires extending from one jurisdiction to another, and mass-casualty incidents with fire and hazardous materials concerns are examples of incidents with complex problems


ICS Command Staff

• Command comprises the incident commander (IC) and command staff

• Command-staff positions are established to assign responsibility for key activities not specifically identified in the general staff functional elements

• These positions may include the public information officer (PIO), safety officer (SO), and the liaison officer (LNO), in additional to various others as required and assigned by the IC


Unified Command

• Unified command (UC)– Multi-jurisdictional or multi-agency domestic

incident management– It provides guidelines to enable agencies

with different legal, geographic, and functional responsibilities to coordinate, plan, and interact effectively


Unified Command (Cont.)

• Unified command (UC)– Unified command overcomes much of the

inefficiency and duplication of effort that can occur when agencies from different functional and geographic jurisdictions, or agencies at different levels of government, operate without a common system or organizational framework


Unified Command (Cont.)

• Unified command (UC)– The primary difference between the single

command structure and the UC structure is that in a single command structure, the IC is solely responsible for establishing incident management objectives and strategies In a UC structure, the individuals designated by

their jurisdictional authorities jointly determine objectives, plans, and priorities, and they work together to execute them


General Staff

• General staff– Incident management personnel who

represent the major functional elements of the ICS Operations section chief, planning section chief,

logistics section chief, and finance/administration section chief

– Command staff and general staff must continually interact and share vital information and estimates of the current and future situation and develop recommended courses of action for consideration by the IC


Area Command

• Area command– Established either to oversee the

management of multiple incidents that are being handled by separate ICS organizations or to oversee the management of a very large incident that involves multiple ICS organizations


FIGURE 14.2Area Commander Responsibilities.


Divisions and Groups

• The use of divisions and groups in the command organization provides a standard system to divide the incident into smaller, more manageable elements

• Divisions – Represent geographic responsibilities, such

as Branch C (the rear of the facility)


Divisions and Groups (Cont.)

• Groups– Represent a functional (job) responsibility,

such as the treatment group

• Divisions and groups are under the control of a "supervisor" (e.g. medical group supervisor or transportation group supervisor)


Branches

• An organizational level having functional or geographical responsibility for major aspects of incident operations


Branches (Cont.)

• A branch is organizationally situated between the operations section chief and the division or groups in the operations section, and between the logistics section chief and the units in the logistics section


Branches (Cont.)

• Branches are established to assist in maintaining the proper span of control during major incidents when there are numerous divisions and/or groups operating


NIMS ICS Applied to EMS Incidents

• The ICS is used during all EMS incidents– Someone is always in charge, although hr

or she typically is not referred to as the incident commander

– Rescue/extrication group supervisor


NIMS ICS Applied to EMS Incidents (Cont.)

• The ICS is used during all EMS incidents– Medical group supervisor – Triage unit leader – Treatment unit leader – Transportation group supervisor – Heilispot manager


FIGURE 14.3Basic Incident Management Structure for EMS Incidents.


FIGURE 14.5Air Operations at an EMS Incident.


Available NIMS ICS Training

• ICS-100, Introduction to ICS• ICS-200, Basic ICS• ICS-300, Intermediate ICS• ICS-400, Advanced ICS• ICS-700, Orientation to the NIMS• ICS-800, Federal Response Plan


Mass-Casualty Terminology

• Mass casualty incidents– Incidents resulting from man-made or

natural causes resulting in illness or injuries that exceed or overwhelm the EMS and hospital capabilities of a locality, jurisdiction, or region

– A mass-casualty incident is likely to impose a sustained demand for health and medical services rather than the short, intense peak demand for these services typical of multiple-casualty incidents


Mass-Casualty Terminology (Cont.)

• Mass casualty incidents– An EMS agency should plan to designate in

the dispatch center a predetermined response matrix A predetermined response matrix sends a

specific group of resources to an incident Some agencies have developed a first-alarm

medical assignment similar to a first-alarm fire assignment


Resource Allocation

• As a single resource, ambulances have been identified by type and capability

• Each ambulance team will need to be able to work 12-hour shifts

• Backup supplies and some equipment required according to the number of patients and the type of event may be necessary; for example, backboards, oxygen, or added medications


Resource Allocation (Cont.)

• Communication equipment must be programmable for interoperability

• Fuel supply and maintenance support must be available

• Environmental considerations related to temperature control in patient-care compartment and pharmaceutical storage may be necessary for locations with excessive ranges in temperature



• Security for the vehicle may be required for periods of standby, when the crew cannot be in attendance

• Decontamination supplies and support for crews may be required for responses to incidents with the potential for infectious disease patients



• Ambulance strike team – A group of five ambulances of the same

type with common communications and a leader



• EMS task force– A team comprised of five resources in any

combination (within span of control) of resources (e.g., ambulances, rescues, engines, squads) assembled for a medical mission, with common communications and a leader or supervisor


Pre-planning Special Events

• Multiple casualties can be generated at planned events

• The size of the event crowd also can dictate what generates calls

• Certain events by their very nature suggest the type of patients that may be seen


Incident Action Plans (IAPs)

• The planning section creates and puts together the written action plan with the approval of the incident commander

• The IAP includes the overall incident objectives and strategies established by the IC or UC


Incident Action Plans (IAPs) (Cont.)

• The planning section is responsible for developing and documenting the IAP

• In the case of UC, the IAP must adequately address the overall incident objectives, mission, operational assignments, and policy needs of each jurisdictional agency


Incident Action Plans (IAPs) (Cont.)

• This planning process is accomplished with productive interaction between jurisdictions, functional agencies, and private organizations

• The IAP also addresses tactical objectives and support activities for one operational period, generally 12 to 24 hours


FIGURE 14.8Components of an Incident Action Plan (IAP).


FIGURE 14.9Federal Forms in an IAP. (Ask your instructor to download form examples from Pearson’s IRC.)


Summary

• Throughout the transition to the National Incident Management System, it is important to remember why we have the NIMS and why ICS is a critical piece of the incident management system


Summary (Cont.)

• Most incidents are local, but when emergency responders are faced with the worst-case scenario, such as September 11, 2001, all responding agencies must be able to interface and work together well

• The NIMS, in particular the ICS component, allows that to happen, but only if a good foundation has been laid at the local level


Summary (Cont.)

• If local jurisdictions adopt a variation of ICS that cannot grow or is not applicable to other disciplines, the critical interface between responding agencies and jurisdictions cannot occur when the response expands

Documents

Incident Management