Hospital Incident Command System

1. Hospital Incident Command System Milton Hospital Hospital Incident Management Meg Femino Emergency Management Program

2. It is a clear, crisp spring afternoon at Milton Hospital. At 4:07pm, you are thrown from your office chair to the floor by a sudden and violent earthquake. Electrical power in your office is immediately lost as the severe shaking continues for well over 1 minute.

3. Objectives • Discuss how the life cycle of an incident is managed through • Incident notification • Situation analysis and monitoring • Emergency Operations Plan (EOP) activation • Operation of the Hospital Command Center (HCC) • Hospital Incident Command System Team (HICS) • Incident Action Planning • Communication and coordination • Demobilization • System recovery

4. Initial Incident Notification An incident is • An emergent event that disrupts or threatens to disrupt normal operations-explosions vs. outbreak • A planned event in the hospital or community • Notification may come from • Law Enforcement, EMS, Fire, Public Health • Weather forecast • Emergency Management

5. Incident Notification Critical information to obtain • Type of incident, including specific hazard/agent • Location of incident • Numbers and types of injuries • Special actions being taken (e.g., decontamination) • Estimated time of arrival of first EMS units • Pre-hospital treatment

6. Internal Incident Notification • Notification • Communication to relevant personnel of important information regarding an actual or potential hazard impact and the response status of the organization • Code Disaster • Activates our internal Emergency Operations Plan • Authorized by the Administrator on Duty

7. Code Disaster Levels Code Disaster FYI: • Informational alert only Code Disaster MINI: • Limited in scale or scope • Activates Command, Chiefs and Key Leaders Code Disaster MAXI: • Extensive response action required • Large incident

8. Incident Notification • Response • Measures to protect safety of staff and patients • Timely notification of incident management personnel via multiple communication systems • For incidents recognized by hospital, notification of appropriate external agencies, such as: Law Enforcement, Fire, EMS, Public Health, Other hospitals, Emergency Management

9. Emergency Operations Plan Activation • Decisions based on situation assessment, often with incomplete information include: • Activate emergency response or maintain normal operations • Partial or complete activation • Revision of clinical care practices as needed • Considerations • Scope of incident • Impact or likely impact on the facility • Impact on normal operations

10. Emergency Operations Plan Activation • Actions following activation decisions • Timely notification to other key hospital personnel, by rehearsed procedures for multiple communication systems • Potential opening of the Hospital Command Center, not all incidents require the use of an HCC • A Incident Command Post may be established near the event to manage the event initially

11. Emergency Operations Plan Activation Authority • Identified personnel with decision making authority per EOP • Administrator on Duty • Nursing supervisor • Senior emergency department physician • Senior emergency department nurse

12. The Hospital Command Center (HCC) The HCC is pre-identified location for a hospital’s incident management team to convene and coordinate response activities, resources, and information Nangeroni Conference Room 617-696-0275

13. The Hospital Command Center (HCC) • Designated space for • Coordination among incident management team members • HICS personnel to access position-specific tools • Radio, telephone, and support equipment • Decision-making information (electronic and written display boards) • Plans, reference manuals, directories, maps, supplies, etc.

14. The Hospital Command Center (HCC) • Communication and information management resources: • Voice systems (landline, cellular, satellite, commercial two-way radio) • Data systems- computers • Television • Incident information displays (large projection screens, white boards, maps, chart pads on easels) • HICS forms and general office supplies • Fax machine • Photocopier

15. The Hospital Command Center (HCC) • HICS personnel in the HCC • Command staff and Section Chiefs • Medical/Technical Specialists • External agency representatives • Administrative support staff • Others in nearby rooms assigned to Sections or in business offices • Numbers expand and contract according to the course and needs of the incident

16. What have we done?

17. Situation Analysis and Monitoring • Sources of external situation information • WebEOC • EMS: incident reports by radio, telephone, personnel • Public Health • Law Enforcement • Health and Medical Services (ESF 8) in local Emergency Operations Center (EOC) • On-scene Incident Command Post • Local and national media

18. Situation Analysis and Monitoring • Sources of internal situation information • Periodic updates from incident management team members, as scheduled or as situation warrants • Limited tours of key areas within facility • Real-time or recorded surveillance of critical areas • Local and national media

19. Incident Command System (ICS) • Component of the National Incident Management System (NIMS) • Provides a universal structure and process to manage the organization’s response and recovery activities • TJC requirement

20. National Incident Management System (NIMS) • Established post 9/11 by Homeland Security Presidential Directive 5 • Ensures all levels of government have capability to work efficiently together using a national approach to domestic incident management

21. What is HICS?Hospital Incident Command System It is a standardized, all-hazard incident management concept Allows its users to adopt an integrated organizational structure • Matching the complexities and demands of a single or multiple incidents • Not hindered by jurisdictional boundaries

22. Purpose of HICS • Using best practices, HICS ensures: • Safety of responders and others • Achievement of tactical objectives • Efficient use of resources

23. History of HICS • Weaknesses in incident management before HICS • Lack of accountability • Poor Communication • Lack of planning process • Overload Incident Commanders • No method to integrate interagency requirements

24. History of HICS 1980’s FIRESCOPE used ICS for Southern CA wildfires 1987 CA adapts ICS to hospitals Since 1987 Revised four (4) times HICS Provides organized system to manage incidents & addresses weaknesses

25. Basic Features of HICS • Adaptable to any type of emergency • Common terminology • Modular organization • Management by objectives • Reliance on a Incident Action Plan (IAP) • Chain of command and unity of command • Unified command

26. Basic Features of HICS • Manageable span of control • Comprehensive resource management • Information and intelligence management • Integrated communications • Transfer of command • Accountability • Mobilization

27. Milton HICS Chart

28. HICS 5 Major Functional Areas

29. HICS Management: Command • Command • Sets the objectives • Devises strategies and priorities • Maintains overall responsibility for managing the incident

30. AOD Safety/Rad Safety on-call Safety/Rad Safety on-call Public Affairs on-call Public Affairs on-call Varies w/ Incident Varies w/ Incident • Safety Officer • Advises Incident Commander on incident safety • Works with Operations Section to provide for safety of field personnel • Provides for safety of all incident personnel • The Incident Commander (AOD) • Only position always filled in an incident regardless of nature • May be able to accomplish all five management functions alone on small scale incidents • Larger incidents may require that each function be established as a separate Section • Public Information Officer (Public Affairs) • Advises Incident Commander on information dissemination and media relations • Obtains information from and provides information to Planning Section • Obtains information from and provides information to community and media Medical/Technical Specialist A subject matter expert in the field: Biological / Infectious Disease Chemical / Radiological Pharmacist Risk Management Legal Affairs • Liaison Officer • Serves as point of contact for agency representatives supporting the operations • Provides briefings to and answers questions from supporting agencies HICS Command Roles INCIDENT COMMANDER SAFETY OFFICER PUBLIC INFORMATION OFFICER LIAISON OFFICER MEDICAL/TECHNICAL SPECIALIST FINANCE/ADMIN SECTION CHIEF PLANNING SECTION CHIEF LOGISTICS SECTION CHIEF OPERATIONS SECTION CHIEF PATIENT CARE BRANCH DIRECTOR SITUATION TEAM LEADER

31. HICS Management: Operations • Operations • Conducts the tactical operations • Carries out the plan using defined objectives • Directs all needed resources • Business continuity • Safety and security • Health and medical

32. HICS Management: Planning • Planning • Collects and evaluates information for decision support • Maintains information on current and forecasted situation • Maintains resource status • Prepares documents such as the Incident Action Plan • Maintains documentation for incident reports

33. HICS Management: Logistics • Logistics • Provides support to incident • Order all resources from off-site locations • Provide facilities, transportation, supplies, equipment maintenance, fueling, feeding, communication and medical services for responders

34. HICS Management: Finance • Finance • Monitors cost related to the incident • Provides accounting, procurement, time recording, and cost analyses

35. HICS Job Action Sheets (JAS) • Each position has a prioritized job action sheet • These forms should be tailored to BIDMC for optimal functionality • Specific actions that are immediate, intermediate and extended • At bottom of each JAS is correlating HICS forms to be used • These forms are available in the HCC

36. HICS Functional Responsibility • Command- pointers • Strategy, global responsibility • Define mission, ensure completion • Operations- doers • Implements plan, direct tactics • Planning- thinkers • Collect/analyze data, direct planning • Continuity of operations

37. HICS Functional Responsibility • Logistics- getters • Support resource • Environment and materials • Finance- counters • Track Money, ensure documentation • Maximize recovery, reduce liability

38. HICS Sections • Sections • Organizational levels with responsibility for a major functional area of the incident • The person in charge is the Chief

39. HICS 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 • Units • Organizational elements that have functional responsibility for a specific activity

40. HICS Transfer of Command • Moves the responsibility for incident command from one Incident Commander to another • Must include a transfer of command briefing • Oral • Written • Both oral and written

41. Staffing the Incident Management Team • Activating HICS positions • The Incident Commander (IC) is the first to respond • IC determines level of staffing according to the functional needs of the hospital response • Positions might be filled initially by in-house mid-level staff until senior personnel arrive • Some individuals might function in multiple positions simultaneously throughout the entire response or until additional personnel become available

42. Staffing the Incident Management Team • Incident briefing of the General Staff to include: • Response priorities • Initial problems • Answers to initial questions and concerns • Updated operational briefings to be provided at regular intervals

43. Incident Action Planning • The Incident Action Plan (IAP) • A document intended to help the incident management team establish and communicate response objectives, identify response needs, and resolve obstacles associated with meeting objectives • A useful tool for transition of operations activities to relief personnel • Understanding policy and direction • Assessing the situation • Establishing incident objectives

44. The Incident Planning Process • Determining appropriate strategies to achieve the objectives • Providing tactical direction and ensuring that it is followed • Example: The correct resources assigned to complete a task and their performance monitored • Providing necessary back-up • Assigning more or fewer resources • Changing tactics

45. Reports of widespread damage throughout the hospital, on 2 North patient rooms have staff and patients killed, trapped or injured inside. Flooding is reported in the basement and Pharmacy needs to evacuate.Now, what is the situation?

46. HICS Key Points • Benefits of HICS are: • Manages routine or planned events • Establishes a clear chain of command • Provides a a common structure • Provides logistical and administrative support to operational personnel • Ensures key functions are covered and eliminates duplication

47. HICS Key Points • HICS is modular and scalable to the scope and magnitude of the incident • Incident Commander always activated • Other positions activated as needed • There are five management functions • Command • Operations • Planning • Logistics • Finance

48. HICS Key Points • HICS provides a common terminology and position titles to enhance standardization among agencies and responders • HICS structure is flexible • Span of control • Integrates with other hospitals and responding agencies

49. Communication and Coordination • Information exchange within the hospital and/or healthcare system • Phone, intranet, email, or fax to and from departments • Assigned radio channels to and from specific areas • Online or printed forms to and from hospital personnel • Situation updates and/or response guidance via radio, internet, print material, or face-to-face meetings

50. Communication and Coordination • Information exchange within the hospital and/or healthcare system • Wireless communication devices, teleconferencing, 2-way radio • “Town Hall” meetings, involving key incident management personnel and appropriate Medical/Technical Specialists