Incident Management for Healthcare

1. Incident Management for Healthcare Based upon Emergency Management Institute ICS-100HC

2. MERET worked with partners in Minnesota to adapt curriculum to support the Hospital Incident Command System (HICS) training Minnesota Emergency Readiness Education and Training Program (MERET) MERET is a program designed to educate and train Minnesota’s health care workers in emergency preparedness, tailoring efforts to the unique needs of specific communities as they prepare for a health emergency or bioterrorism event. MERET is funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services, and is administered by the University of Minnesota Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN, at the School of Nursing, is the Principal Investigator. Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum Development Program.

3. Incident Command System (ICS) Objectives • Identify organizational structure of HICS. • Review unique position titles and responsibilities in HICS. • Identify major functions within the ICS structure. • Name the purpose for an incident command post and the designated location within your facility. • Describe what an Incident Action Plan is and how it is used in an incident. • Recall the overall priorities of an Incident Action Plan. • Discuss responsibilities associated with assignments under the ICS. • In order to maintain an appropriate span of control, name the categories that resources might be divided into.

4. Incident Command System (ICS) History • FIRESCOPE – 1970s • NIIMS (National Interagency Incident Management System) • NIMS (National Incident Management System) • MnIMS (MN Incident Management System) • OSHA (Occupational Safety and Health Administration • NFPA 1600 (National Fire Protection Association) • The Joint Commission (formerly JCAHO) • Requires healthcare facilities to use community-congruent IMS

5. Homeland Security Presidential Directives (HSPDs) HSPD-5 • Management of Domestic Incidents http://www.whitehouse.gov/news/releases/2003/02/20030228-9.html HSPD-8 • National Preparedness • http://www.ojp.usdoj.gov/odp/assessments/hspd8.htm Mandates • National Incident Management System (NIMS) • National Response Plan (NRP) • National Preparedness Goal www.fema.gov

6. National Incident Management System/Components (NIMS) • NIMS: Standardizes incident management processes, protocols, and procedures for all responders. Mandates ICS • Command and Management • ICS • Multi-Agency Coordination • Public Information Systems • Preparedness • Resource Management • Communications and Information Mgt. • Supporting Technologies • Ongoing management and Maintenance http://www.dhs.gov/xprepresp/committees/editorial_0566.shtm

7. National Response Plan Establishes . . • Incidents occur and are managed at the lowest level • Provision of federal aid to support state and local efforts as requested. • Unified, all-discipline, all-hazard, management approach http://www.dhs.gov/xprepresp/committees/editorial_0566.shtm

8. NIMS & NRP Relationship National Incident Management System (NIMS) Standardized process and procedures for incident management NIMS aligns command & control, organization structure, terminology, communication protocols, resources and resource typing Incident DHS integrates and applies Federal resources Local Support or Response Resources, knowledge, and abilities from all Federal agencies State Support or Response Federal Support or Response NRP is activated forIncidents of National Significance National Response Plan (NRP) Activation and proactive application of integrated Federal resources http://www.nrt.org/production/NRT/NRTWeb.nsf/AllAttachmentsByTitle/A-319CharlieHessNIMS-NRPBrief/$File/Charlie_Hess_NIMS-NRP_Brief.ppt?OpenElement#324,6,NIMS & NRP Relationship

9. Tiered Response Strategy Capabilities and Resources Federal Response State Response Regional / Mutual Response Systems Local Response, Municipal and County Minimal Low Medium High Catastrophic Increasing magnitude and severity 'Medical Surge Capacity and Capability Handbook' by J. Barbera and A. Macintyre published by CNA Corporation.

10. Hospital Incident Management

11. What Is an Incident? . . . an occurrence, either caused by human or natural phenomena, that requires response actions to prevent or minimize loss of life, or damage to property and/or the environment. Photos courtesy of FEMA Photos courtesy of FEMA

12. What is a ‘disaster’? • A disaster is when the demands of an ‘incident’ outstrip available resources • Goal: Get the… • Right stuff / staff to the • Right place at the • Right time to prevent an incident from becoming a… • DISASTER • Incident management is the key!

13. Le Sueur Tornado Photographer: D. Burgess. Photo courtesy of NOAA Photo Library

14. Red River Flood Photographer: David Saville, Photos courtesy of FEMA

15. Photographer: Mark Wolfe, Photo courtesy of FEMA

16. Emergencies Present In 2 Ways… Unanticipated and/or Without Warning Anticipated and/or With Warning Oklahoma City Bombing Hurricane Katrina Tornado Midwest Floods Northridge Earthquake Pandemic Flu The Amount of Time We’re Given To Pre-Organize People and Pre-Stage Equipment Can Drastically Change Our Response Effectiveness Illustration courtesy of Pete Brewster – VA Medical System

17. Incident progression Reactive Phase Recognition Notifications Initial control and safety actions Primary Tools SOPs Job Action Sheets Primary Goal Prevent incident expansion Prevent responder injury Proactive Phase Situation assessed Objectives established Strategies / tactics Resources requested Primary Tools ICS Incident Action Planning Primary Goal Manage incident BOOM! Slide courtesy of John Hick Hennepin County Medical Center

18. ICM Feature:Mobilization • Review hospital Emergency Operations Plan (EOP) notification procedures • Identify how you would be notified of an incident • Identify what your appropriate preliminary response actions would include

19. School Shooting Image courtesy of FEMA, Photographed by Jocelyn Augustino

20. What is an Incident Command System (ICS)? • A structured system for controlling: • Personnel • Facilities • Equipment • Communications Photographer: Jocelyn Augustino, Photo courtesy of FEMA

21. What is the Hospital Incident Command System (HICS)? • Created in the 1980’s as Hospital Emergency Incident Command System (HEICS) and Evolved to HICS as a comprehensive incident management system for both emergent and non-emergent situations . • Foundation for more than 6,000 hospitals in the United States to prepare and respond to disasters • Hospital are seen as essential members of community preparedness and are recognized as “first responders” in emergency response. • The HICS provides a common structure and language for promoting interagency communication based on functions • Evolved from an Incident Command System (ICS) used by multiple agencies to manage events

22. What does ICS do? • Provides framework to: • Identify and assess the problem • Develop plan to deal with the problem • Implement the plan • Procure and pay for necessary resources

23. Why use ICS? • Greater efficiency in managing internal or external crisis • Improved communication – internally and externally • Standardization and flexibility to meet the needs of incidents of any kind or size • To provide logistical & administrative support to ensure that operational staff can meet tactical objectives • To be effective in reducing costs by avoiding duplication of efforts • To allow personnel from different organizations to use a common management structure Photographer: Marvin Nauman, Photo courtesy of FEMA

24. When should ICS be used? • ANY incident that requires something OTHER than day-to-day organizational structure and function (e.g.: special event planning) • Utility of ICS depends on frequent use in order to maintain familiarity with structures/function • No correlation between the ICS organization & administrative agency structure; every incident requires different management functions

25. Weaknesses prior to ICS • Lack of accountability • Poor communication • Lack of planning process • Overloaded commanders • Interagency integration – ICS purposely does not reflect agency-specific titles, etc. to avoid confusion

26. Common Terminology Modular Organization Management by Objectives Reliance on an Incident Action Plan (IAP) Chain of command & unity of command Unified Command Manageable span of control Pre-designated incident locations & facilities Resource Management Information & Intelligence Management Integrated Communications Transfer of Command Accountability Mobilization Incident Management System (IMS) Features…

27. IMS Feature: Common Terminology • Common terminology must be used! • Plain English (not codes) • Ensures efficient, clear communication • Position titles, not person (e.g.: operations chief, not ‘nursing supervisor’) – titles are a common standard for all users • Resource typing – ‘tanker’ • Facility terminology – ex. ‘command post’ ‘command center’ • LIMIT what you say to essential info

28. IMS Feature: Pre-designated Key Facilities and Locations • Incident Command Post – where the Incident Commander oversees the incident • Emergency Operations Center – multi-agency center supporting operations • Staging area / Labor pool – where available stuff or staff await assignment S Slide courtesy of FEMA

29. IMS Feature: Pre-designated Key Facilities and Locations H • Helibase • Location from which helicopter-centered air operations are conducted • Helibases are generally used on a more long-term basis and include such services as fueling and maintenance • Helispot • Are more temporary locations at the incident, where helicopters can safely land and take off. • Multiple Helispots may be used H-3 Slide courtesy of FEMA

30. Basic ICS Structure –ModularOrganization Slide courtesy of FEMA

31. IC – Incident Commander • Provides overall leadership for incident response • Only position ALWAYS staffed • Receives authority from ‘agency executive’ – e.g. hospital CEO to conduct incident (agency exec continues to manage day-to-day issues) ideally in writing • Delegates authority to others • May appoint deputy if needed • Initial IC holds post until they delegate the post to another qualified / more qualified person

32. IMS Feature: Chain of Command, Unity of Command • Chain of command – orderly line of authority, lower levels subordinate to higher • Unity of command – every individual is responsible to ONE supervisor during an incident – they should know who this person is and how to contact them

33. IMS Feature: Single versus Unified Command • Single command – one organization and single IC has complete responsibility for incident (hospital receives victims from train crash) • Unified command – multiple agencies / organizations share responsibility (hospital on fire and evacuating – hospital, EMS, fire form unified command) (do not confuse with unity of command)

34. IMS Feature:Transfer of Command • More qualified person / team arrives • End of operational period / extended incident handoff • Always includes transfer of command briefing • Current situation • Response needs • Available resources

35. Command Staff General Staff Incident Commander • The Incident Commander performs all major ICS command and staff responsibilities unless delegated and assigned. Public Information Officer Incident Commander Liaison Officer Incident Commander Safety Officer Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief Slide courtesy of FEMA

36. Command Staff Command Staff • The Incident Commander may need to designate staff who can provide information, liaison, and safety services for the entire organization Public Information Officer Incident Commander Liaison Officer Incident Commander Safety Officer Slide courtesy of FEMA

37. Advises Incident Commander on information dissemination and media relations. IC approves information releases by the PIO to external stakeholders Incident Commander Obtains information from and provides information to Planning Section for internal stakeholders. Planning Section Chief Obtains information from and provides information to community and media. Community and Media Public Information Officer (PIO) Public Information Officer Slide courtesy of FEMA

38. ICS Feature: Integrated Communications • Procedures and processes for transferring information internally and externally • Modes of communication between facility and external agencies (hardware) • Planning for use of the hardware – integrated communications

39. Risk assessments Resource situation Epidemiology Weather Map / geodata Structural information Toxin information Environmental information (monitoring) Utility data Threat data ICS Feature: Information & Intelligence Sharing Must have a process to gather, manage, and share incident information

40. Advises Incident Commander on issues regarding incident safety. Incident Commander Works with Operations to ensure safety of field personnel. Operations Section Chief Ensures safety of all incident personnel. Incident Personnel Safety Officer Safety Officer Slide courtesy of FEMA

41. Assists Incident Commander by serving as point of contact for agency representatives who are helping to supportthe operation (but are not directly under the ICS). Incident Commander Provides briefings to and answers questions from supporting agencies. Agency Representative Liaison Officer Liaison Officer Slide courtesy of FEMA

42. Command Incident Commander Sections Operations Section Chief Branches Units Single Resources Groups Divisions Expanding Incidents • Add to the supervisory layers as the incident expands Slide courtesy of FEMA

43. Sample “Build Outs” Immediate Extended Slide courtesy of FEMA

44. Sample “Build Outs”: Immediate Slide courtesy of FEMA

45. Sample “Build Outs”: Extended Slide courtesy of FEMA

46. General Staff • General Staff in the ICS organizational structure are appointed as the incident complexity expands Incident Commander Public Information Officer Command Staff Liaison Officer Safety Officer General Staff Operations Section Planning Section Logistics Section Finance/Admin Section Slide courtesy of FEMA

47. IMS Feature:Span of control • In an emergency, if you are responsible for direct supervision of more than 5 persons, consider a new ‘division of labor’ (3-7 persons answering to a supervisor range) • Safety, accountability, efficiency Graphic courtesy of FEMA

48. What Influences Span of Control? Span of control is influenced by: • The type and complexity of incident or event • The nature of the response or task, communications, distance, weather • Training or experience of personnel • Safety risks http://training.fema.gov/EMIWeb/IS/ICS200CR/ICS200IGPDF/02ICS200LeaderSept05.pdf

49. Basic ICS Structure Organization INCIDENT COMMANDER LIAISON OFFICER SAFETY OFFICER INFORMATION OFFICER OPERATIONS SECTION FINANCE SECTION PLANNING SECTION LOGISTICS SECTION Responsible for the conduct of tactical operations, formulation of tactical objectives & organization, & direction of tactical resources Slide courtesy of FEMA

50. Maintaining Span of Control • The following supervisory levels can be added to help manage span of control: by organizing resources into Divisions, Groups, Branches or Sections Divide an incident geographically. Example east and west wing of hospital Divisions Groups Describe functional areas of operation. Example, decontamination team Used when the number of Divisions or Groups exceeds the span of control. Can be either geographical or functional. Branches Slide courtesy of FEMA