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Hospital Incident Command System

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Hospital Incident Command System Milton Hospital Hospital Incident Management Meg Femino Emergency Management Program It is a clear, crisp spring afternoon at Milton ... – PowerPoint PPT presentation

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Title: 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 407pm, 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
    hospitals 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 organizations 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
1980s 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
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

51
Communication and Coordination
  • Information for patients and visitors
  • Situation status and actions undertaken by
    hospital
  • Public address system announcements
  • Situational signage at entrances
  • Posted bulletins
  • Print material on meal trays
  • Personal conversations with staff

52
Communication and Coordination
  • Information exchange with external response
    partners
  • Outreach to Law Enforcement, Public Health, Fire,
    and EMS when no notification is received, to
    communicate situation and any request for
    assistance
  • Periodic joint decision-making with hospitals
    receiving victims
  • Patient tracking information with Health and
    Medical Services
  • Communicate resource needs (e.g., medications,
    staffing, transportation)

53
Demobilization
  • Demobilization planning to begin at the outset of
    response
  • Planning Section Demobilization Unit Leader is
    responsible for preliminary plan
  • Timing for full demobilization will vary by
    situation
  • IC decides when to transition from response mode
    to demobilization

54
Demobilization
  • Criteria includes
  • Hospitals ability to manage numbers of incoming
    patients
  • No anticipated secondary rise in patient volume
  • Demobilization by other responders
  • Return to normal operations by other critical
    community infrastructure

55
Demobilization
  • Consultation with Command and General Staff and
    external decision-makers (e.g., other hospitals,
    local EOC)
  • Communication of demobilization decision to
  • Hospital staff
  • Appropriate external agencies (e.g.,
  • Fire/EMS, Law Enforcement, Public Health)
  • Patients and families
  • General public (e.g., when curtailed hospital
    operations to resume)

56
System Recovery
  • Return to routine patient care activities
  • Return of extra equipment, supplies and
    medications
  • Return to normal or new normal operational
    levels
  • Formal debriefing of hospital personnel

57
System Recovery
  • Medical surveillance of personnel exposed to
    hazardous materials or infectious diseases
  • Financial, psychological and medical care issues
    of personnel who became injured or ill on duty
  • Behavioral/mental health support
  • Potential for staff absenteeism or resignations

58
System Recovery
  • Restoration of physical plant
  • Disposal of hazardous waste
  • Clean-up of contaminated areas
  • Safety survey
  • Reimbursement of personnel, patient care,
    resources, equipment repair and replacement, and
    facility operations costs
  • Rebuilding public trust

59
Key Considerations
60
Staff Health and Safety
  • Safety Officer has primary responsibility for
    monitoring safety of incident operations and
    identifying and resolving health and safety risks
  • Trained and authorized personnel with medical
    clearance may use Personal Protective Equipment
    (PPE) and must be monitored

61
Staff Health and Safety
  • Instruction on proper infection control
    precautions provided to staff and patients and
    updated in multiple formats
  • Mass prophylaxis for staff, in coordination with
    local Public Health
  • Effects of fatigue and psychological stress

62
Extended Emergency Operations
  • Issues related to extended operations
  • Personnel impacts
  • Patient care
  • Equipment and supplies
  • Behavioral/mental health
  • Security
  • Infrastructure support
  • Information sharing
  • Media relations

63
Extended Emergency Operations
  • Manage issues through use of Incident Action Plan
  • Coordinate extended operations planning with
    other area hospitals, and local EOC
  • Balance incident response needs with maintenance
    and/or adjustment of normal services and
    operations
  • Provide for relief of hospital staff and rotation
    of HCC personnel

64
Law and Ethics
  • Consult hospital attorney, medical ethicist,
    and/or risk manager in preplanning or response to
    issues such as
  • Managed degradation of care in response to
    surging patient volume
  • Revised scope-of-practice guidelines
  • Confidentiality of patient information
  • Credentialing, privileging, utilization, and
    supervision of volunteers
  • Responsibility for patients who die from illness
    or injury
  • Evidence chain of custody

65
Response Evaluation and Organizational Learning
  • During an incident, time outs can be taken to
    identify and implement adjustments to incident
    management team staffing or policy and procedures
  • Following an incident, debriefings or hot
    washes can be held at various levels

66
Response Evaluation and Organizational Learning
  • After Action Report (AAR) Process
  • Formal record of what worked well and what needs
    improvement
  • AAR draft for submission to Emergency Management
    Committee with improvement recommendations
  • Revisions to Emergency Operations Plan as
    approved and staff training
  • Participation in community AAR process
  • Sharing lessons learned through formal
    presentations

67
Review Key Points
  • The life cycle of an incident is managed through
    HICS functions
  • Critical considerations during incident
    management include staff health and safety,
    extended emergency operations, and law and ethics
  • Improvements to the hospitals emergency
    management program and emergency operations plan
    can be achieved through response evaluation and
    organizational learning
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