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NIMS (National Incident Management System) for Healthcare

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Title: NIMS (National Incident Management System) for Healthcare


1
NIMS (National Incident Management System) for
Healthcare
  • Based upon Emergency Management Institute ICS-700

2
Minnesota Emergency Readiness Education and
Training Program (MERET)
  • MERET worked with partners in Minnesota to adapt
    curriculum to support the Hospital Incident
    Command System (HICS) training

MERET is a program designed to educate and train
Minnesotas 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 OBoyle, 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
Hospital Command General Staff
4
Objectives
  • Identify the key principles of NIMS in the
    context of healthcare.
  • Recall when it is appropriate to initiate an Area
    Command.
  • Name the functions and purpose of a Multiagency
    Coordination Center.
  • Select the appropriate utilization of the Public
    Information Systems within NIMS.
  • Compare how NIMS and HICS affect how healthcare
    prepares for incidents and events.
  • Recognize the concepts and principles of resource
    management under NIMS HICS.
  • Identify the benefits of common communication and
    information management standards.

5
What is NIMS?
  • a consistent nationwide approach for federal,
    state, tribal, and local governments to work
    effectively and efficiently together to prepare
    for, prevent, respond to and recover from
    domestic incidents, regardless of cause, size or
    complexity.
  • - Secretary of Homeland Security directed
    President of USA to develop administer a
    National Incident Management System (NIMS)
  • Homeland Security Presidential Directive /
    HSPD-5, 2003

6
What is NIMS?
  • A comprehensive, national approach to incident
    management
  • Applicable at all jurisdictional levels and
    across disciplines

Slide courtesy of FEMA
7
NIMS Concepts and Principles
  • NIMS is
  • Flexible and Standardized to improve overall
    response and interoperability and enable all
    responding organizations to work together.

Slide courtesy of FEMA
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
National Response Plan (NRP) Activation and
proactive application of integrated Federal
resources
NRP is activated for Incidents of National
Significance
http//www.nrt.org/production/NRT/NRTWeb.nsf/AllAt
tachmentsByTitle/A-319CharlieHessNIMS-NRPBrief/Fi
le/Charlie_Hess_NIMS-NRP_Brief.ppt?OpenElement324
,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
Tiered Response
HCF Health Care Facility
'Medical Surge Capacity and Capability Handbook'
by J. Barbera and A. Macintyre published by CNA
Corporation.
11
NIMS Training Deadlines
  • 1. August 31, 2007 (ISC-100 HC)
  • Emergency Managers (ICS-100 HC, ICS-200 HC,
    ICS-700 and IS-800)
  • Command Staff (ICS-100 HC, ICS-200 HC and
    ICS-700)
  • PIO
  • Liaison Officer
  • Incident Commander (only Commander title)
  • Safety Officer
  • General Staff(ICS-100 HC, ICS-200 HC and ICS-700)
  • Section Chiefs (Operations, Planning, Logistics,
    Financethe only reference to Chiefs)
  • 2. August 31, 2008 (ISC-100 HC)
  • Staff filling boxes below section chiefs

12
NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

Slide courtesy of FEMA
13
NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

14
Command and Management
  • Incident Command System (ICS)
  • Hospital Incident Command System (HICS)
  • You learned this in ICS-100 HC and ICS-200 HC
  • Proven management system based on best practices
  • Span of control may vary from 3 7
  • Use common terminology to reduce confusion
    between ICS position and day-to-day position
  • Embraces management-by-objectives in developing
    Incident Action Plans
  • Recognizes Multiagency Coordination Entity when
    resources cannot be obtained locally

Slide courtesy of FEMA
15
Command and Management
  • In some situations, NIMS recommends variations in
    incident command
  • Most common variations are
  • Unified Command
  • Area Command

Slide courtesy of FEMA
16
Unified Command
  • Used when more than one agency is involved such
    as with a hazardous material spill
  • Collective / collaborative approach

ONE Incident Action Plan
Photos courtesy of FEMA
17
How Does Unified Command Work?
  • Agencies work together to
  • Analyze intelligence information
  • Establish single set of objectives strategies
    for multiple agencies
  • Create single Incident Action Plan (IAP)
  • Improved information flow coordination
  • Agencies understand joint priorities
    restrictions
  • Unified Command does not change other features of
    ICS.

Slide courtesy of FEMA
18
How is Area Command Organized?
Slide courtesy of FEMA
19
What Does Area Command Do?
  • Sets overall strategy and priorities
  • Allocates resources
  • Ensures proper management
  • Ensures objectives are met
  • Ensures strategies are followed
  • Is particularly relevant to public health
    emergencies because incidents where area command
    are used
  • Are not site specific
  • Are not immediately identifiable
  • Are geographically dispersed and evolve over time
  • Area Command does not include an Operations
    Section because operations are conducted
    on-scene.
  • May become a Unified Command Area

Slide courtesy of FEMA
20
How is Area Command Organized?
Slide courtesy of FEMA
21
Command and Management
  • Multiagency Coordination Center
  • For large or wide-scale emergencies
  • Aids in resource allocation decisions based on
    incident priorities
  • Emergency Operations Centers may support the need
    for multiagency coordination and Joint
    Information activities
  • Handles requests for items that IC cannot obtain
    locally

Slide courtesy of FEMA
22
Multiagency Coordination Center (MAC)
  • NOT Area Command
  • Function scope is incident-driven
  • Coordinate incident-related information
  • Resource management center for agencies
  • Strategic planning
  • Surveillance and Epidemiology
  • Patient Care
  • Population-based Interventions
  • Personnel management
  • Liaison with jurisdictional agencies and EOCs to
    coordinate issues regarding incident management
    policies, priorities strategies

Slide courtesy of FEMA
23
MAC
  • Simple and brief in use or complex and protracted
    based on event
  • Coordination Center that can also be activated to
    assist Area Command for
  • Multiple concurrent health-related incidents
  • Incidents that are non-site specific
  • Incidents that are geographically dispersed
  • Incidents that evolve over time

Slide courtesy of FEMA
24
MAC for Health Care
  • EMS
  • Hospitals
  • Public Health
  • Emergency Management
  • Activation
  • Site
  • Staffing
  • Authority

Slide courtesy of FEMA
25
Hospital C
Hospital B
Clinics
Hospital A
Health System
Regional Hospital Resource Center
Multi-Agency Coordination Center EM
EMS PH
A
A
B
B
C
C
A
C
Jurisdiction Emergency Management
B
Public Health Agencies
EMS Agencies
Slide courtesy of John Hicks
26
Command and Management
  • Public Information coordination across responding
    agencies is important for the public to receive
    accurate, timely, and consistent information that
    is easy to understand
  • The Public Information Officer (PIO) is part of
    the command staff
  • PIO operates within the parameters of a Joint
    Information System when established as part of a
    Multiagency Coordination or Area Command
  • Each agency or organization contributing to the
    Joint Information System retains their
    organizational independence while using the Joint
    Information System protocols

Slide courtesy of FEMA
27
NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

28
How Does NIMS Define Preparedness?
  • Taking actions to establish and sustain
    prescribed levels of capability
  • Ensures mission integration and interoperability

Slide courtesy of FEMA
29
Comprehensive Emergency Management Cycle
  • 4 Phases
  • Mitigation prevention or activities that reduce
    impact of hazard
  • Preparedness build response capacity/capability
  • Response gain control of an event
  • Recovery return to pre-disaster state

Slide courtesy of FEMA
30
Community- Based Hazard Vulnerability Analysis
(HVA)
(images courtesy of USA.gov)
31
MDH Regions
Slide courtesy of John Hicks
32
Preparedness
  • Mutual Aid Agreements and Emergency Management
    Assistance Compacts
  • facilitate timely delivery of assistance

Slide courtesy of FEMA
33
Preparedness
  • Metropolitan Hospital Compact
  • Since April 9, 2002
  • 27 hospitals operating 4800 beds
  • 7 counties participate
  • Agreement provides for
  • Staff and supply sharing
  • Staffing off-site facilities for first 48h
  • Communications, JPIC
  • Regional Hospital Resource Center (HCMC)

Slide courtesy of John Hicks
34
NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

35
Resource Management
  • Resource management is an important concept for
    preparedness organizations at all levels and
    helps to
  • Establish guidelines and protocols for resource
    management
  • Establish procedures to track resources from
    mobilization through demobilization
  • Categorize resources (resource typing) based on
    measurable standards of capability and performance

Slide courtesy of FEMA
36
Resource Management
  • Regional Hospital Resource Center (RHRC)
  • Designated hospital in a geographic or functional
    region that is the coordinating hospital for
    information and requests
  • Acts as broker for patient transfers into / out
    of the region
  • May help make allocation decisions for resources
    (eg staffing)
  • Represents hospital needs and issues to
    Multi-Agency Coordination Center

Slide courtesy of John Hicks
37
Capacity vs. Capability
  • Surge Capacity the ability to manage increased
    patient care volume that otherwise would severely
    challenge or exceed the existing medical
    infrastructure
  • Surge Capability the ability to manage
    patients requiring unusual or very specialized
    medical evaluation and intervention, often for
    uncommon medical conditions
  • Barbera and Macintyre

38
Surge Capacity/Patient Care Coordination
MAC
From the Minnesota Department of Health, Pat
Tommet
39
NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

40
Communications Information Management through
the Joint Information System (JIS) Protocols
  • To ensure consistency among all who respond, all
    responding agencies must have a common operating
    picture
  • PIOs operate within the parameters of a JIS
  • Keys to a common operating picture
  • Interoperable communications across all agencies
    and jurisdictions
  • Information systems based on common architecture

Slide courtesy of FEMA
41
Joint Information Center (JIC)
  • Physical location where public information staff
    collocate/organize factual information
  • Provides the structure for coordinating and
    disseminating official/critical information

Slide courtesy of FEMA
42
JIC
Slide courtesy of FEMA
43
JIC Characteristics
  • Includes representatives of all players in the
    response both private and public organizations
  • Has procedures and protocols for communicating
    and coordinating with other JICs
  • May be established at various levels of
    government
  • In case of Unified Commandagencies
    contributing retain their organizational
    independence
  • When multiple JICs are established, each JIC
    contributes to the overall unified message using
    joint information system protocols

Slide courtesy of FEMA
44
JIC Components
Slide courtesy of FEMA
45
NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

46
Supporting Technologies
  • 800MHz radios
  • HAM radios
  • Mission Mode
  • MN-TRAC
  • HAN (Health Alert Network)-

Slide courtesy of FEMA
47
NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

48
Ongoing Management and Maintenance
  • NIMS Integration Center
  • Maintains and manages national-level preparedness
    standards
  • Facilitates definition of general training
    requirements and approved courses
  • Reviews and approves equipment lists meeting
    national standards
  • Defines minimum levels of training, experience,
    fitness, capability and currency by establishing
    certification and credentialing standards for key
    personnel
  • Develops Corrective Action Plan based on lessons
    learned from actual incidents

Slide courtesy of FEMA
49
Group efforts
  • Information sharing (ARC, MAC, CST)
  • Communications (web-based future system, 800Mhz,
    amateur radio)
  • Education (bio, chemical, radiation)
  • Personal Protective Equipment
  • HRSA grant requirements
  • Infectious disease protocols / response
  • Workforce issues
  • Pharmaceutical cache storage and release
  • Drills

Slide courtesy of John Hicks
50
Federal Assets
  • National Disaster Medical System (NDMS)
  • Urban Search and Rescue (eg Nebraska TF-1)
  • Commissioned Corps Readiness Force
  • Military (NORTHCOM)
  • Federal Medical Stations
  • CDC SNS and VMI

Slide courtesy of John Hicks
51
NDMS
  • Disaster Medical Assistance Teams
  • Specialty teams (DMORT, VMAT, Burn, etc)
  • Patient movement
  • Public / private partnership
  • Voluntary commitment of civilian hospital beds
    for defense or disaster use accept casualties
    from affected area
  • Response, evacuation, and definitive care
  • 2000 hospitals, 65 FCCs

Slide courtesy of John Hicks
52
NDMS Patient Movement
  • During crisis, system placed on alert
  • Bed counts submitted to FCC / GPMRC
  • Patient needs matched to beds available
  • Patients arrive by military airlift
  • Distributed to area hospitals
  • Never fully activated until Hurricane Katrina
  • More mass evacuation than transfers

Slide courtesy of John Hicks
53
Summary NIMS Components
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications and Information Management
  • Supporting Technologies
  • Ongoing Management and Maintenance

54
Are You Ready for the Test?
55
MERET Acknowledges its Partners
  • 1. Healthcare System Preparedness Program
    Partners
  • a. Minnesota Department of HealthOffice of
    Emergency Preparedness
  • b. MDH Metropolitan Hospital Compact
  • c. Regional Hospital Resource Center Focus Group
  • Michelle Allen, Northwest
  • Clyde Annala, Northeast
  • Jill Burmeister, South Central
  • Chuck Hartsfield, Central
  • Marla Kendig, Southeast
  • Emily Parsons, MDH-OEP
  • Justin Taves, West Central
  • Eric Weller, South Central
  • 2. FEMA Independent Study Program
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