ICS for Clinicians

1. ICS for Clinicians What We Need to Know Why We Need to Know It November 2006

2. ICS: Module 1 Features and Principles November 2006

3. Acknowledgements These training materials were developed by Kay Koelemay, MD and Jeffrey Duchin, MD Public Health – Seattle & King County with support from the University of Washington and The National Institutes of Health Region X Center of Excellence for Biodefense and Emerging Infectious Diseases • Questions? Public Health 206-296-4774 November 2006

4. ICS: Incident Command System November 2006

5. What Is ICS? • ICS is a management system • Evolved from system to coordinate management of wildfires • Component of NIMS (National Incident Management System) • Mandated component of local incident response plans in Washington State, including pandemic influenza • It is the standard for incident management November 2006

6. Fires, Hazardous Spills November 2006

7. Acts of Terrorism November 2006

8. National Response Plan (NRP) National Incident Management System (NIMS) Incident Command System (ICS) Interrelationships NRP NIMS ICS November 2006

9. Natural Disasters November 2006

10. Hospital Incident Command System (HICS) November 2006

11. Benefits of ICS • Coordinates response to incidents of any kind • Allows personnel from variety of agencies to meld into a common management structure • Provides logistical and administrative support to operational staff • Is cost effective, avoiding duplication of efforts • Ensures consistency • Increases information sharing • Decreases confusion through the coordination of responders November 2006

12. Healthcare System Response to a Medical Disaster • Every healthcare facility will be impacted, no matter how small • Patients seek medical care in familiar settings • Hospital ERs can be overwhelmed • Treatment may be adequately managed in clinic setting • Events may be prolonged in duration, generating patients to be evaluated in daily clinic operations November 2006

13. Scenario Tuesday, September 19, in Seattle • You are surprised to be swamped with patient visits for an influenza-like illness (ILI): • acute onset of fever and chills • sore throat • body aches • runny nose • Some have a rash; a few have a nasty conjunctivitis. November 2006

14. Scenario • Several of your employees have called in sick with similar symptoms. 2-3 days after onset, quite a few of these patients have developed increasingly severe chest complaints: • some have a cough • others complain of chest tightness or pain • It acts like a bad bronchitis. November 2006

15. Scenario Wednesday, September 20 • When you call to admit a previously-healthy 8 year-old with worsening bronchopneumonia and a pleural effusion, you learn that the hospital is overwhelmed with referrals for severe respiratory illness. In fact, all the hospitals in King County are experiencing the same influx of patients. Public Health has been notified. November 2006

16. Scenario Same day • One of your patients tells you that she heard a news report that a large number of the 4-H animals at the Western Washington Fair are ill and dying. The fair is in its second week. The newscaster had said that there is growing concern about a connection to the human flu-like illness that is going around. November 2006

17. Scenario Thursday, September 21 • The Governor of Washington and the State Secretary of Health, along with officials of the Department of Homeland Security hold a press conference. Tularemia has been diagnosed both in 4-H animals and in humans who have attended the fair. There is strong evidence that there has been an intentional aerosol dispersal of tularemia bacteria on the fairgrounds. The fair is closed on its 13th day of operation. November 2006

18. Questions, anyone? • Do all of these patients with influenza-like illness (ILI) have tularemia? • How do we treat this? Is it treatable? • Where do I get this information? • How will I handle all the patient calls and requests for visits? • What about protection and other safety measures for me and my family, my staff and my patients? • Do we need prophylaxis? How do we get it? Who is responsible? • What are the guidelines for medical evaluation and laboratory tests? How reliable are the lab tests? • Who is making these decisions and recommendations? • Who determines if there are populations at increased risk? • Do I need to report any information? Where do I send it? • What if more of my staff gets sick? Where can I get more staff? • Where do I get more information and guidance????? November 2006

19. That is why you need… ICS November 2006

20. Francisella tularensisWhat is it? • Aerobic, gram-negative coccobacillus • Extremely infectious via: • Contaminated environments • Tick, fly or mosquito bites • Almost entirely a rural disease • Natural reservoirs – small mammals • Infection through skin, mucous membranes, GI tract and lungs (most likely BT entry) November 2006

21. Tularemia: what is the treatment? • Illness: oral doxycycline x 14-21 days or ciprofloxacin x 10 days • Exposure: Fever watch x 14 days with treatment for unexplained fever or ILI • No PEP (post-exposure prophylaxis) to contacts; no human → human transmission • No isolation of tularemia patients recommended http://www.bt.cdc.gov/agent/tularemia/ November 2006

22. Incident of National Importance • Is a large incident that: • involves multiple organizations • not immediately identifiable • is non-site specific/ geographically dispersed • evolves over days or weeks • Area Command: oversight of management with multiple incident management teams • Each team will function under ICS November 2006

23. Basic Features of ICS: 1 • Common terminology • Modular organization • Management by objectives • Reliance on an Incident Action Plan (IAP) • Chain of command and unity of command • Unified Command • Manageable span of control November 2006

24. Basic Features of ICS: 2 • Pre-designated incident facilities • Resource management • Information and intelligence management • Integrated communications • Transfer of command • Accountability • Mobilization November 2006

25. Common Terminology • Helps to define: • Incident facilities • Position titles • Organizational functions • Resource descriptions • Use “clear text;” avoid jargon, radio codes or agency specific codes • In other words…use plain English! November 2006

26. Why Common Terminology? EMT = Emergency Medical Technician EMT = Emergency Management Team EMT = Eastern Mediterranean Time (GMT+0200) EMT = Electron Microscope Tomography EMT = Email Money Transfer ICU = Intensive Care Unit ICU = Influenza Coordination Unit (CDC) November 2006

27. Modular Organization • Develops in a modular fashion • Based on the size, complexity of incident • Based on the hazard environment • Incident objectives determine organizational size. • Only necessary functions/positions are filled. • Each element must have a person in charge. November 2006

28. Management by Objectives • Understand agency policy/direction • Assess incident situation • Establish incident objectives, based on the following priorities #1: Life Saving/ Safety #2: Incident Stabilization #3: Property Preservation • Select appropriate strategies • Perform tactical direction • Provide necessary follow-up November 2006

29. Incident Action Plan (IAP) • What do we want to do? • Who is responsible for doing what? • How do we communicate? • What happens if someone is injured? • The IAP covers a specified timeframe, called an operational period (often = 12 hours) • May be oral or written, depending on incident November 2006

30. Chain of Command/ Unity of Command • Chain of command is an orderly line of authority within the ranks of the incident management organization. • Under unity of command, personnel: • Report to only one supervisor. • Receive work assignments only from their supervisors. Don’t confuse unity of command with Unified Command! November 2006

31. Unified Command (UC) • Enables all responsible agencies to manage an incident together by establishing a common set of incident objectives and strategies. • Allows agency leads (Incident Commanders) to make joint decisions by establishing a single command structure. • Maintains unity of command. • Each employee only reports to one supervisor. November 2006

32. Span of Control • The number of individuals or resources that one supervisor can manage effectively during an incident. • Is between 3 and 7 subordinates. • Optimally does not exceed 5 subordinates. • Use modular organization to maintain November 2006

33. Incident Command Post or “EOC” (Emergency Operations Center) Staging Area Base Heliport Pre-designated Facilities November 2006

34. Resource Management • Processes for: • Categorizing resources. • Ordering resources. • Dispatching resources. • Tracking resources. • Recovering resources. • Processes for reimbursement for resources, as appropriate. November 2006

35. Resources: Tactical • Personnel and major items of equipment used in the operation • Assigned – currently working under direction of a supervisor • Available – ready for immediate assignment with all appropriate equipment • Out-of-service – not available November 2006

36. Resources: Support • All other resources required to support the incident, including: • Food • Communication equipment • Supplies • Medical support November 2006

37. Information & Intelligence Management • The incident management organization must establish a process for gathering, sharing and managing incident-related information and intelligence. • Public information must be coordinated and integrated across functional agencies • Joint Information Center “JIC” November 2006

38. Integrated Communications • A common communications plan • Interoperability of communication equipment, procedures, systems & protocols. • Modes: The "hardware" systems • Planning: Planning for the use of all available communications resources. • Networks: Procedures and processes for transferring information internally and externally. November 2006

39. Transfer of Command • Moves the responsibility for incident command from one Incident Commander to another • Must include a transfer of commandbriefing (oral, written, or both) • Occurs when: • A more qualified person assumes command. • Situation changes; legal requirement to change • Normal turnover of personnel on extended incidents • Incident response is concluded November 2006

40. Accountability: 1 • Check-In: All responders must report in to receive an assignment. • Check in at designated site only once • Incident Action Plan: Response operations must be coordinated as outlined in the IAP • Unity of Command: Each individual is assigned to only one supervisor November 2006

41. Accountability: 2 • Span of Control: Supervisors must be able to adequately supervise and control their subordinates, as well as communicate with and manage all resources under their supervision. • Resource Tracking: Supervisors must record and report resource status changes as they occur. November 2006

42. Mobilization • Personnel and equipment should respond only when requested or when dispatched by an appropriate authority • The situation must be assessed and the response planned. • Managing resources safely and effectively is the most important consideration. November 2006

43. ICS: Module 2 Organizational Functions and Command Types November 2006

44. Organizational Function November 2006

45. ICS: Basic Functional Structure Command Operations Planning Logistics Finance/ Administration November 2006

46. Incident Commander (IC) and Command Staff November 2006

47. Incident Commander • Incident safety • Information services to internal and external stakeholders • Liaison with other agencies participating in the incident • Responsibility for all activities and functions until delegated and assigned to staff • Assessment of need for additional staff • Incident goals, objectives, overall direction November 2006

48. Command Staff • Safety Officer - advises IC on issues regarding incident safety and ensures safety of all incident personnel • Liaison Officer - assists IC by serving as point of contact for agency representatives who are helping to support the operation • Public Information Officer (PIO) -advises IC on information dissemination and media relations to and from the community and media November 2006

49. General Staff • Operations • Planning • Logistics • Finance/Administration • (Intelligence, if required) • The leader of each section is titled “Chief” November 2006

50. Operations Section • Establishes strategy and tactics to carry out the incident objectives • Organizes, assigns, and supervises resources • Directs and coordinates all operations • One of the first organizations assigned to the incident • Expands from the bottom up November 2006