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National Incident Management System (NIMS) National Response Framework (NRF) Hospital Incident Command System (HICS) IS

National Incident Management System (NIMS) National Response Framework (NRF) Hospital Incident Command System (HICS) IS 100.HC, 200.a, 700.a, 800.b The University of South Alabama Center for Strategic Health Innovation.

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National Incident Management System (NIMS) National Response Framework (NRF) Hospital Incident Command System (HICS) IS

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  1. National Incident Management System (NIMS) National Response Framework (NRF) Hospital Incident Command System (HICS) IS 100.HC, 200.a, 700.a, 800.b The University of South Alabama Center for Strategic Health Innovation © University of South Alabama Center For Strategic Health Innovation. All Rights Reserved. These slides are a part of the ARRTC program and cannot be reproduced for commercial purposes.

  2. NIMS National Incident Management System • A standardized, all-hazard incident and resource management concept. • A comprehensive, national approach to incident management that is applicable to all jurisdictional levels and across functional disciplines. (700-2-4) • The intent is to be applicable across a full spectrum of potential incidents and hazard scenarios, regardless of size or complexity. (700-2-3) • Designed to improve coordination and cooperation between public and private entities in domestic management activities. • Response actions will be based on the ICS system. • All First Responders comply with NIMS training requirements.

  3. NIMS National Incident Management System Established to create uniformity: • Organization Structure (ICS) • Plans • Training/Exercises Organization • Resources • Communications/Technology

  4. NIMS Implementation Activities for Hospitals • Similar to expectations placed on government agencies • Consists of 14 objectives for FY 2009 • We will cover all requirements in detail in the next section: “Update on NIMS Requirements”.

  5. NIMS Compliance • HSPD-5 issued in 2004 • For disaster response agencies and departments, NIMS made a condition for Federal assistance • Confusion over initial NIMS compliance for hospitals and healthcare facilities • Initial compliance date Oct 1, 2006 pushed back to Oct 1, 2007. • Annual FY requirements and 5-year plan (700-2-7)

  6. National Response Framework Went into effect in March 2008. Updated and revised the National Response Plan. The NRF establishes . . . • Federal coordination structures/mechanisms • Direction for incorporation of existing plans • Consistent approach to managing incidents Coordination (700-3-5)

  7. Relationship: NIMS vs. NRF • NIMS • Aligns command, control, organization structure, terminology, communication protocols, & resources/resource-typing • Used for all events Resources Knowledge Federal • NRF • Integrates & applies Federal resources, knowledge, & abilities before, during, & after an incident • Implemented for incidents requiring Federal coordination Abilities Response or Support State Response or Support Local Response Incident (700-3-5)

  8. Major disasters, emergencies, and terrorist incidents including threats Other events of lesser severity requiring a coordinated Federal response NRF Applicability The NRF applies to all Federal departments and agencies that have primary jurisdiction for or participate in operations requiring a Federal response, including:

  9. Incidents of National Significance The NRF distinguishes between: • Incidents that require the Secretary of Homeland Security to manage the Federal response, termed Incidents of National Significance, and, • The majority of incidents occurring each year that are handled by responsible jurisdictions or agencies DHS Secretary must declare an event as an Incident of National Significance

  10. NRF Structure Base Framework Describes the domestic incident management structures and processes Include acronyms, definitions, authorities, and a compendium of national interagency plans Appendixes Describe the structures and responsibilities for coordinating incident resource support Emergency Support Function Annexes - 15 Support Annexes Provide guidance for the functional processes and administrative requirements Incident Annexes Address contingency or hazard situations requiring specialized application of the NRF

  11. Scope of Emergency Support Functions ESF #1 – Transportation Department of Transportation • Aviation/airspace management and control • Transportation safety • Restoration/recovery of transportation infrastructure • Movement restrictions • Damage and impact assessment ESF #2 – Communications Homeland Security/NCS • Coordination with telecommunications and information technology industries • Restoration and repair of telecommunications infrastructure • Protection, restoration, and sustainment of national cyber and information technology resources • Oversight of communications within the Federal incident management and response structures ESF #3 – Public Works and Engineering Department of Defense US Army Corps of Engineers • Infrastructure protection and emergency repair • Infrastructure restoration • Engineering services and construction management • Emergency contracting support for life-saving and life-sustaining services ESF #4 – Firefighting Department of Agriculture • Coordination of Federal firefighting activities • Support to wildland, rural, and urban firefighting operations

  12. Scope of Emergency Support Functions ESF #5 – Emergency Management Homeland Security/FEMA • Coordination of incident management and response efforts • Issuance of mission assignments • Resource and human capital • Incident action planning • Financial management ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services Homeland Security/FEMA • Mass care • Emergency assistance • Disaster housing • Human services ESF #7 – Logistics Management and Resource Support Homeland Security/FEMA • Comprehensive, national incident logistics planning, management, and sustainment capability • Resource support (facility space, office equipment and supplies, contracting services, etc.) ESF #8 – Public Health and Medical Services Dept Health & Human Srvcs. • Public health • Medical • Mental health services • Mass fatality management

  13. Scope of Emergency Support Functions ESF #9 – Search and Rescue Homeland Security/FEMA • Life-saving assistance • Search and rescue operations ESF #10 – Oil and Hazardous Materials Response EPA • Oil and hazardous materials (chemical, biological, radiological, etc.) response • Environmental short- and long-term cleanup ESF #11 – Agriculture and Natural Resources Department of Agriculture • Nutrition assistance • Animal and plant disease and pest response • Food safety and security • Natural and cultural resources and historic properties protection and restoration • Safety and well-being of household pets ESF #12 – Energy Department of Energy • Energy infrastructure assessment, repair, and restoration • Energy industry utilities coordination • Energy forecast

  14. Scope of Emergency Support Functions ESF #13 – Public Safety and Security Department of Justice • Facility and resource security • Security planning and technical resource assistance • Public safety and security support • Support to access, traffic, and crowd control ESF #14 – Long-Term Community Recovery Homeland Security/FEMA • Social and economic community impact assessment • Long-term community recovery assistance to States, local governments, and the private sector • Analysis and review of mitigation program implementation ESF #15 – External Affairs Homeland Security/FEMA • Emergency public information and protective action guidance • Media and community relations • Congressional and international affairs • Tribal and insular affairs

  15. ICS Incident Command System

  16. HICS is: • A Proven Emergency Management System Based on Military and Fire Management Chains of Command • Designed for all hazards and all sizes of response, as necessary • Flexible and adaptable – only activate what is needed. • Manages routine or planned events • Provides logistical & administrative support to operational personnel • Improves Communication – Formal and Informal • Cost effective – avoids duplication of effort • Allows for adaptation into a common response structure (100-2-16; 200-2-9; 200-6-5/7)

  17. Characteristics of ICS • Common Terminology (100-3-6/9) • Modular organization • Reliance on an Incident Action Plan (IAP) • Management by objectives • Chain of command and Unity of command (200-2-6) • Unified Command (700-6-17) • Manageable Span of Control (100-3-19/21; 200-3-4) • Emergency Operations Centers • Resource Management • Information, Intelligence and Communications

  18. ICS Terminology Sections Divisions Groups Branches Task Forces Strike Teams Resources

  19. Sections • Organizational levels with responsibility for a major functional area of the incident • Operations • Planning • Logistics • Finance/Administration • The person in charge is the Chief

  20. Divisions and Groups Divisions • Divide an incident geographically • Is led by a Supervisor Groups • Established based on the needs of an incident. • Labeled according to the job that they are assigned • Managed by a Supervisor • Work wherever their assigned task is needed and are not limited geographically

  21. Branches and Units Branches • Established if the number of Divisions or Groups exceeds the span of control • Have functional or geographical responsibility for major parts of incident operations • Managed by a Branch Director (200-4-24) Units • Organizational elements that have functional responsibility for a specific activity

  22. Task Forces • Task Forces are a combination of mixed resources with common communications • Operate under the direct supervision of a Task Force Leader

  23. Strike Teams Strike Teams are a set number of resources • Of the same kind and type • With common communications • Operate under the direct supervision of a Strike Team Leader

  24. Resources • Single: An individual(s) or piece of equipment with its personnel complement; or, • A crew or team of individuals with an identified supervisor • Staging Areas hold resources waiting for operational assignment. (100-3-26; 200-4-19) • Typing: Identifies size, capability and staffing qualifications. (200-6-14) • Assigned, Available or Out-of-Service (100-4-4)

  25. ICS Supervisory Titles • Distinct titles = most qualified 2. Standard titles = easy requests 3. Titles = common standard • (100-5-10; 200-2-41; 200-4-7)

  26. Other Command Issues& Terms Initiation of Command Transfer of Command Termination of Command Demobilization (700-5-15, pg 121) - Facilitates accountability Credentialing (700-5-23, pg 129) - Competence and proficiency Area Command, On-Scene Command (700-6-20, pg 155) - multiple incidents handled by separate IC orgs.

  27. Specific Command Issues Initiation of Command: • IC or Temporary IC need to know what they do • Must be able to recognize the need to activate HICS • Need a list of criteria to make the decision • Have a group or select staff to ask for advice • Update EOP with “Activation” section • Need to understand “Transfer of Command”

  28. Specific Command Issues Transfer of Command: • Follow EOP guidelines after “Initiation of Command” • Upon arrival, the higher ranking individual will assume command, maintain command or reassign to a third party.(200-7-5) • Delegation of authority can occur if the scope of the response is complex or beyond capabilities or authority. (200-3-8) • All with a need to know should be told the effective time and date of the transfer.(200-7-6)

  29. Specific Command Issues Termination of Command: • IC needs to know what they do • Must be able to recognize the time to de-activate HICS • Need a list of criteria to make the decision • Have a group or select staff to ask for advice • Update EOP with “Activation” section • Need to understand demobilization and what is involved

  30. Specific Command Issues • Demobilization: The process of standing down • Getting back to a normal schedule and routine • Replacing equipment and supplies • Adjusting personnel back to routine • Planning begins at the same time as mobilization • Facilitates accountability and efficiency • Occurs in the Planning Section • (700-5-15)

  31. Specific Command Issues Credentialing: Evaluation and documentation of an individual's: • Current certification, license, or degree • Training and experience • Competence or proficiency • Critical for health care agencies • National, state, local AND agency requirements • Legal implications (700-5-23)

  32. Specific Command Issues Area Command: Creates to oversee the management of: • Multiple incidents that are each being handled by an Incident Command System organization • A very large incident that has multiple Incident Management Teams assigned to it • Designed to ensure the effective management of assigned incidents (700-6-20)

  33. Management by Objectives Incident Occurs Incident Reported & Identified Tactical Response ICS Launched Chiefs Meeting: Develop Strategy & Tactics to Meet Objectives IC Sets Objectives Incident Action Plan (200-5-7) (100-3-15/18) (700-6-11) Chiefs & Officers Set Meeting with IC to Re-evaluate Tactical Response Initiated Operation Reports Tactical Results, Needs, Engage Liaison, Logistics, Planning, Finance for support Planning Evaluates Progress Reports

  34. ICS Form 201 – Incident Briefing Form An eight-part form that provides an Incident Command/Unified Command with basic information that can be used to brief incoming resources, an incoming Incident Commander or team, or an immediate supervisor. The basic information includes the: Incident situation (map and significant events). Incident objectives. Summary of current actions. Status of resources assigned to or ordered for the incident or event. Can serve as the initial Incident Action Plan (IAP) for the first shift change and will remain in force and continue to develop until the response ends, or until a Planning Section has been established and generates, at the direction of the Incident Commander, an IAP. Suitable for briefing assigned and newly arriving Command and General Staff members. (200-4-38)

  35. ICS Form 201 Page 1 of 8 pages See handouts

  36. Incident Command SystemOrganizational Charts Theoretically, your ICS chart should not correlate with any administrative organizational chart in you facility: Creates confusion over position titles and duties. (100-5-3) In reality, for hospitals, an HICS chart that matches (or comes close to matching) your day-to-day organizational chart is much more effective and understood during an event.

  37. Incident Command System (ICS) Model Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer (100-5-17) Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff (100-5-17; 200-6-6; 700-6-15)

  38. HOSPITAL INCIDENT COMMAND SYSTEM HICS (2003)

  39. HOSPITAL INCIDENT COMMAND SYSTEM HICS (2006)

  40. The Five Sections • Command = the buck stops here • Planning = creates & develops incident plan • Operations = implement the plan. • Logistics = supports the plan. • Finance = pays for the plan.

  41. ICS – Command Section Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff

  42. Incident Commander • Manages all emergency activities, including development, implementation, and review of strategic decisions from the Command Post, as well as post event assessment during recovery. Top priority = Safety! (100-3-26; 200-2-15; 700-6-5; 700-6-11) • Serves as the authority for all emergency response efforts and supervisor to the Public Information Officer (PIO), Liaison Officer, Safety Officer, Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance & Administration Section Chief. • May serve as any or all of the positions in the Command and General Staff depending on the complexity of the event. • Is IC until authority is transferred to another person. (100-5-7) • The only position ALWAYS staffed in an ICS activation. (100-5-6)

  43. Public Information Officer • Responsible for relaying incident related information to the public, other organizations and the media. (100-5-18; 700-6-30) • Participate in a Joint Information System (JIS) and work in the local Joint Information Center (JIC) when activated. • Communicates with other agencies’ public information officers. • Be the organizer of correct information. • Manage the facility’s Public Information Plan.

  44. Safety & Security Officer • Monitors, evaluates and recommends procedures for all incident operations for hazards and unsafe conditions. • Monitors, evaluates and recommends procedures for all incident operations, including the health and safety of emergency responder personnel. • Organizes and reinforces scene/facility protection and traffic. • Establish a security command post. (100-5-18)

  45. Liaison Officer • Is responsible for coordinating with external partners, such as the city, state, federal agencies, and public and private resource groups, as well as other Health Care Facilities. • Serves as the incident contact person for representatives from other agencies and may work from the local Emergency Operations Center. • Communicates into and out of the hospital. • Works closely with the IC and PIO (100-5-18; 200-4-11/12)

  46. Legal Officer • Provides legal and ethical advice to the IC, Command Staff, General Staff and the agency. • Brought about by recent issues in hospitals in New Orleans post Katrina.

  47. Incident Command System (ICS) Model Incident Commander Public Information Officer Liaison Officer Command Staff Safety & Security Officer Logistics Section Chief Planning Section Chief Finance/Admin Section Chief Operations Section Chief General Staff

  48. Logistics Section “Boy, do I need stuff”

  49. Logistics Chief • Organize and direct operations associated with the maintenance of the physical environment: • Food • Shelter • Supplies • Comms Equipment • Transportation • Medical support (100-6-34; 200-4-32)

  50. Logistics Chief Facility Unit Leader Communications Unit Leader Transport Unit Leader Materials Supply Unit Leader Nutritional Supply Unit Leader

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