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Incident Management for Healthcare

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MERET is a program designed to educate and train Minnesota's health ... and Capability Handbook' by J. Barbera and A. Macintyre published by CNA Corporation. ... – PowerPoint PPT presentation

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Title: Incident Management for Healthcare


1
Incident Management for Healthcare
  • Based upon Emergency Management Institute
  • ICS- HC 100-200

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
Objectives
  • Name the four (4) phases of comprehensive
    incident management.
  • Recognize how objectives shift from the initial
    response phase to the extended response phase.
  • Name the order in which the Hospital Incident
    Command System (HICS) is usually activated.
  • Select the forms used by the Command and General
    Section Chief staff.
  • Identify the role of the Incident Commander.
  • Select the appropriate span of control for any
    leadership position in the HICS.
  • Identify the purpose of the Incident Briefing.

4
What is the Hospital Incident Command System
(HICS)?
  • Created in the 1980s 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

5
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

6
What is the Hospital Incident Command System
(HICS)?
  • Created in the 1980s 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

7
Homeland Security Presidential Directives (HSPDs)
  • Management of Domestic Incidents
    http//www.whitehouse.gov/news/releases/2003/02/20
    030228-9.html

HSPD-5
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

Slide courtesy of FEMA
8
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

Slide courtesy of FEMA
9
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

10
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
11
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

12
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.
13
Hospital Incident Management
14
What is meant by an incident in the Incident
Command System?
  • . . . 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
15
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!

16
Le Sueur Tornado
Photographer D. Burgess. Photo courtesy of NOAA
Photo Library
17
Red River Flood
Photographer David Saville, Photos courtesy of
FEMA
18
Photographer Mark Wolfe, Photo courtesy of FEMA
19
Emergencies Present In 2 Ways
Unanticipated and/or Without Warning
Anticipated and/or With Warning
Oklahoma City Bombing
Hurricane Katrina
Tornado
Midwest Floods
Pandemic Flu
Northridge Earthquake
The Amount of Time Were Given To Pre-Organize
People and Pre-Stage Equipment Can Drastically
Change Our Response Effectiveness
Illustration courtesy of Pete Brewster VA
Medical System
20
Incident progression
Reactive Phase Recognition Notifications Initial
control and safety actions Establish
ICP 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
21
Incidents Require you to ..
22
School Shooting
Image courtesy of FEMA, Photographed by Jocelyn
Augustino
23
What is an Incident Command System (ICS)?
  • Provides framework to
  • Identify and assess the problem
  • Develop plan to deal with the problem
  • Implement the plan
  • Procure and pay for necessary resources
  • A structured system for controlling
  • Personnel
  • Facilities
  • Equipment
  • Communications

Photographer Jocelyn Augustino, Photo courtesy
of FEMA
24
Why use ICS?
  • Greater efficiency in managing internal or
    external crisis incidents of any kind or size
  • Better coordination and communication within and
    external to facility
  • Standardization and flexibility which allows
    personnel from different organizations to use a
    common management structure
  • 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

Photographer Marvin Nauman, Photo courtesy of
FEMA
25
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

26
Incident Command System (ICS) Features
  • 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

Slide courtesy of FEMA
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

Slide courtesy of FEMA
28
Basic ICS Structure Modular Organization
Slide courtesy of FEMA
29
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
30
Incident Commander
  • Only position always staffed
  • Ensures safe work practices
  • Provides overall leadership for incident response
  • Initial IC holds post until they delegate the
    post to another qualified/more qualified person
  • Demonstrates initiative by taking action
  • Motivates responders
  • Communicates by providing specific instructions
    and asking for feedback
  • Supervises the scene of the action
  • Delegates authority to others
  • Understands and accepts the need to be flexible,
    modify plans
  • Approves Incident Action Plan and evaluates its
    effectiveness

Slide courtesy of FEMA
31
Delegation of Authority
  • An Incident Commander's scope of authority is
    derived
  • From existing responsibilities or agreements
  • Through a delegation of authority from the agency
    administrator or elected official in writing or
    verbally
  • Grants authority to carry out specific functions
    and provides overall objectives / guidance
  • Allows the Incident Commander to assume command.
  • Does NOT relieve the granting authority of the
    ultimate responsibility for the incident.
  • Delegation of authority comes from the governing
    board of your agency

Slide courtesy of FEMA
32
Transfer of Command-Review
  • The process of moving the responsibility for
    incident command from one Incident Commander to
    another
  • Occurs when
  • More qualified person / team arrives
  • End of operational period / extended incident
    handoff
  • Always includes transfer of command briefing
  • Current situation
  • Response needs
  • Available resources
  • All personnel will be informed of the effective
    time and date of the transfer of command

33
Public Information Officer (PIO)
Public Information Officer
Slide courtesy of FEMA
34
Safety Officer
Safety Officer
Slide courtesy of FEMA
35
Liaison Officer
Liaison Officer
Slide courtesy of FEMA
36
Expanding Incidents
  • Add to the supervisory layers as the incident
    expands

Slide courtesy of FEMA
37
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
38
Incident Command System Span of Control
  • Relates to the supervisory structure of the
    organization and pertains to the number of
    individuals or resources one incident supervisor
    can effectively manage
  • 1-5 is the recommended ratio
  • Organizing resources into Sections, Branches,
    Groups, Divisions, Units or Teams when the
    supervisory ratio will exceed 7 or demobilizing
    when the supervisory ratio falls below 3.

Slide courtesy of FEMA
39
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
Describe functional areas of operation. Example,
decontamination team
Groups
Used when the number of Divisions or Groups
exceeds the span of control. Can be either
geographical or functional.
Branches
Slide courtesy of FEMA
40
Basic ICS Structure Organization
INCIDENT COMMANDER
LIAISON OFFICER
SAFETY OFFICER
INFORMATION OFFICER
OPERATIONS SECTION
FINANCE SECTION
PLANNING SECTION
LOGISTICS SECTION
  • Responsible for determining the appropriate
    tactics for an incident, conduct of tactical
    operations, formulation of tactical objectives
    organization, direction of tactical resources

Slide courtesy of FEMA
41
Operations Section Divisions
  • Divided geographically
  • Labeled using alphabet characters (A, B, C,
    etc.).
  • Managed by a Supervisor

Division B
Division A
https//intranet.ahc.umn.edu/ahcimages/Buildings/F
rameSet.htm
42
Operations Section Groups
  • Established based on the needs of an incident.
  • Labeled according to the job that they are
    assigned.
  • Work wherever their assigned task is needed and
    are not limited geographically.

Operations Section
Decontamination Group
Patient Care Group
Slide courtesy of FEMA
43
Operations Section 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.
  • Branch Director

Operations Section
Medical Care Branch
Security Branch
Business Continuity Branch
Infrastructure Branch
Slide courtesy of FEMA
44
Staging Manager is a new area for Hospital
Incident Command
  • Operations Function
  • Responsible for deploying resources
  • May have several staging areas
  • Medications
  • Staff (Labor pool)
  • Transportation
  • Resources within the Staging Areas are available
    and ready for assignment (rest and repair areas
    are NOT located at staging)

45
Branches that are essential for maintaining
hospital operations
  • Medical Care Branch
  • Responsible for the provision of medical care of
    the incident victims and patients already in the
    hospital
  • Infrastructure Branch
  • Facilitates the acquisition and access to
    essential recovery resources
  • Security Branch
  • Responsible for security for facility and staff,
    liaison with local agencies
  • Business Continuity Branch
  • Facilitates the acquisition and access to
    essential recovery resources

46
Operations Section Specialized individual or
team of individuals needed for the incident
  • Task forces mixed resources, common mission (
    task force, search and rescue task force)
  • Strike Teams same resource (Code Blue,IV Team,
    water-mopping and mass immunization strike team)
  • Single Resources individuals or team of
    individuals

47
Basic ICS Structure Modular Organization
INCIDENT COMMANDER
LIAISON OFFICER
SAFETY OFFICER
INFORMATION OFFICER
OPERATIONS SECTION
PLANNING SECTION
FINANCE SECTION
LOGISTICS SECTION
Slide courtesy of FEMA
48
Planning Section
  • Prepares documents the Incident Action Plan,
    collects evaluates information, maintains
    resource status, maintains documentation for
    incident record

Slide courtesy of FEMA
49
Planning Section Resources Unit
  • Conducts all check-in activities and maintains
    the status of all incident resources.
  • Plays major role in preparing the written
    Incident Action Plan and maintaining planning
    cycle.

Planning Section
Resources Unit
Demobilization Unit
Situation Unit
Documentation Unit
Slide courtesy of FEMA
50
Planning Section Situation Unit
  • Collects and analyzes information on the current
    situation.
  • Prepares situation displays and situation
    summaries.
  • Develops maps and projections.
  • Patient and bed tracking functions

Planning Section
Planning Section
Resources Unit
Demobilization Unit
Situation Unit
Documentation Unit
Slide courtesy of FEMA
51
Planning Section Documentation Unit
  • Provides duplication services, including the
    written Incident Action Plan.
  • Maintains and archives all incident-related
    documentation.

Planning Section
Planning Section
Resources Unit
Demobilization Unit
Situation Unit
Documentation Unit
Slide courtesy of FEMA
52
Planning Section Demobilization Unit
Planning Section
Planning Section
Assists in ensuring that resources are released
from the incident in an orderly, safe, and
cost-effective manner.
Resources Unit
Demobilization Unit
Situation Unit
Documentation Unit
Slide courtesy of FEMA
53
Planning Section Technical Specialists
  • Provide special expertise useful in incident
    management and response.
  • May be assigned to work in the Planning Section
    or in other Sections.
  • Advise the Incident Commander and/or assigned
    Section on issues related to emergency response
    in their area of expertise
  • May be assigned as technical advisor in the HCC
  • May be assigned to advise and oversee specific
    hospital operations

54
Basic ICS Structure Modular Organization
INCIDENT COMMANDER
LIAISON OFFICER
SAFETY OFFICER
INFORMATION OFFICER
OPERATIONS SECTION
PLANNING SECTION
FINANCE SECTION
LOGISTICS SECTION
Slide courtesy of FEMA
55
Logistics Section - NIMS
Logistics Section
  • Responsible for
  • Meeting the operational objectives
  • Communications
  • Medical support to incident personnel
  • Food for incident personnel
  • Supplies
  • Facilities
  • Ground support, Transportation

Support Branch
Service Branch
Supply Unit
Commun. Unit
Facilities Unit
Medical Unit
Ground Unit
Food Unit
Slide courtesy of FEMA
56
Slide courtesy of FEMA
57
IMS Feature Resource Management
  • Categories
  • Tactical Resources
  • Personnel and major equipment used in the
    operation
  • Support
  • All other resources required to support the
    incident e.g., communications, food, other
    equipment, or supplies

Photographer Ed Edahl Photo courtesy of FEMA
58
Tactical Resources Classifications
Assigned Currently working on an assignment
under the direction of a supervisor Available
Ready for immediate assignment and has been
issued all required equipment Out of Service
Not available or ready to be assigned
Slide courtesy of FEMA
59
Basic ICS Structure Modular Organization
INCIDENT COMMANDER
LIAISON OFFICER
SAFETY OFFICER
INFORMATION OFFICER
OPERATIONS SECTION
PLANNING SECTION
FINANCE SECTION
LOGISTICS SECTION
Slide courtesy of FEMA
60
Finance/Administration Section
  • Responsibilities include
  • Timekeeping
  • Cost analysis / cost data
  • Handling claims related to property damage or
    fatalities

Finance/Admin Section
Time Unit
Compensation/ Claims Unit
Procurement Unit
Cost Unit
Photos courtesy of FEMA
61
Incident Complexity Analysis
  • Safety issues
  • Impacts to critical operating systems
  • Potential need to evacuate
  • Potential need to relocate services
  • Impact on essential resources and suppliers
    (e.g. water supply)
  • Impact on organizations reputation
  • Determine the objectives necessary to manage an
    incident (Incident Action Planning)

Photos courtesy of FEMA
62
IMS Feature Incident Action Planning (IAP)
  • Reflects the overall strategy for managing an
    incident within a prescribed timeframe the
    operational period (e.g. 7am-7pm)
  • IAP is primary source of objectives for action
  • IAP often includes list of resources and
    assignments
  • IAP may initially be verbal, but should become
    written soon in the process
  • Monitors response to adjust for next period
  • Documents results

63
Managing by Objectives Incident Action Plan (IAP)
  • There is only one Incident Action Plan at an
    incident which identifies
  • WHAT must be done?
  • WHO is responsible?
  • How information will be COMMUNICATED?
  • What if a responder is INJURED?
  • Overall Priorities
  • Life Saving
  • Incident stabilization
  • Property Preservation
  • Establish Incident Action Plan objectives,
    strategies, tactics

64
IAP Establishes Objectives, Strategies, and
Tactics
  • State what will be accomplished (agency exec and
    IC)

Incident Objectives
  • Establish the general plan or direction for
    accomplishing the incident objectives (IC)

Strategies
Tactics
  • Specify how the strategies will be executed.
    (Operations)

Photos courtesy of FEMA
65
Operational Times Initial response
phase Extended response phase
  • Initial Response Phase
  • Operational periods set by IC usual breakdown
  • Immediate 0-2 hours
  • Intermediate 2-12
  • Extended over 12 hours
  • Initiate planning cycle
  • Extended Response Phase
  • Incident requires additional operational period
    (incident durationgt8-12 hour)
  • Determined by
  • Situation assessment
  • Incident action planning
  • Resource management

66
Incident Action Planning
  • Forms to include in the IAP
  • HICS 201 Incident Briefing (may serve as initial
    IAP)
  • HICS 202 Incident Objectives
  • HICS 203 Organization Assignment List
  • HICS 204 Branch Assignment List
  • HICS 205 Incident Communications Log
  • HICS 206 Staff Medical Plan
  • HICS 261 Incident Safety Analysis

67
HICS 201 Form (Incident Briefing)
1. Incident Name, 2. Date of Briefing 3. Time of
Briefing 4. Event History 5. Current Actions
6. Summary 7. Current Organization 8. Notes
(Accomplishments, Issues, Directives) 9.
Name of the individual who
prepared the document 10. Facility Name
1. Incident Name, 2. Date of Briefing 3. Time
of Briefing 4. Event History 5. Current
Actions 6. Summary 7. Current
Organization 8. Notes (Accomplishments,
Issues, Directives) 8. Name of the
individual who prepared the document 9.
Facility Name
68
HICS 202 Form (Incident Objectives)
1. Incident name 2. Date prepared 3. Time
prepared 4. Operational period ( date time) 5.
General command control objectives for the
incident (including alternatives) 6.
Weather/environmental implications during the
period (forecast, wind speed/direction, daylight)
7. General safety/staff messages to be given 8.
Attachments (ex. medical plan, facility system
status) 9. Name of the individual who prepared
the document 10. Approval of the Incident
Commander 11. Facility name
69
Mobilization Checking In/ Incident Briefing
  • Check In
  • Officially logs you in at the incident
  • To ensure personal accountability
  • Track resources
  • Receive assignment
  • Know your responsibilities, (Job Action Sheets)
  • Identify location for work, rest, staging areas
  • Shift duration
  • Procedure for getting staff/stuff
  • Safety procedures and Personal Protective
    Equipment (if relevant)
  • Receive an incident briefing from your supervisor

70
Job Action Sheets (JAS)
  • 1. Title
  • 2. Purpose
  • 3. To whom they report
  • 4. Critical action considerations
  • 5. Forms required by the job
  • 6. Broken into operational periods
  • Immediate 0-2 hours
  • Intermediate, 2-12 hours
  • Extended, gt12h
  • JAS prompts the team member to take needed
    actions related to their roles and
    responsibilities

71
Activation of Organizational Elements
  • ICS organizational structure should include only
    the functions and positions needed to achieve the
    incident objectives
  • Organizational elements may be activated without
    activating the Section Chief.
  • In this case, the unit reports to the IC directly
  • Deputy positions can be found for the Incident
    Commander, Branch and Section Chiefs

Incident Commander
Safety Officer
Situation Unit
Operations Section
Rescue Group
Medical Group
Photos courtesy of FEMA
72
Things To Avoid
  • Do not combine ICS positions to save on
    staffing. Individuals may supervise multiple
    units, but the positions should remain distinct.

Bob
Bob
Supply and Facilities Unit Leader
Supply Unit Leader
Facilities Unit Leader
  • Do not use nonstandard titles or hybrid
    positions. These titles may be unrecognizable to
    assisting or cooperating personnel.

Photos courtesy of FEMA
73
Planning Meeting Develop strategies tactics
to Accomplish objectives
Incident is recognized Notifications, assessment,
Immediate needs are addressed
Incident Manager Sets overall incident
objectives priorities
Action Plan preparation approval
Management Meeting Evaluates revises incident ob
jectives
On-going situation assessment
information processing
Operations Briefing Briefs the operational leaders
on the Action Plan
Assess progress using measures of effectiveness
Implement Action Plan
United States Coast Guard
74
ICS Communication System
  • Improves communication internally and
    externally
  • Standardizes terminology
  • Allows accountability
  • Two Types of communication
  • Formal follow lines of authority when
  • Receiving and giving work assignments
  • Requesting support or additional resources
  • Reporting progress on assigned tasks
  • Informal communication does not follow lines of
    authority
  • Is used to exchange incident or event information
    only
  • Allows for documentation on HICS Forms

75
Chain of Command (Single,
Unity)
Incident Commander
Orderly Line of Authority Single Command
Public Information Officer
Command Staff
Liaison Officer
Safety Officer
General Staff
Operations Section Chief
Planning Section Chief
Logistics Section Chief
Finance/Admin Section Chief
HAZMAT Branch Director
Medical Care Branch Director
Service Branch Director
Support Branch Director
  • Unity of command
  • Means that each employee answers to ONE
    supervisor

Photos courtesy of FEMA
76
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
  • Collective / collaborative approach
  • Single set of objectives for multiple agencies
  • Improved information flow and coordination
  • Agencies understand joint priorities and
    restrictions
  • Single IAP

Photos courtesy of FEMA
77
Information and Intelligence Within ICS
  • Establishes a process for gathering, sharing, and
    managing incident related information and
    intelligence
  • Assures that internal information is safeguarded
    but also ensures availability to those who need
    it to perform their jobs effectively and safely.
  • Often handled within Planning, Situation Unit
  • However, in some situations may require
  • As a branch within Operations
  • Within the Command Staff
  • As a separate General Staff Section

78
Types of Briefings/Meetings
  • Staff-Level Briefings Delivered to resources
    assigned to non-operational and support tasks at
    the Incident Command Post or Base.
  • Field-Level Briefings Delivered to individual
    resources or crews assigned to operational tasks
    and/or work at or near the incident site.
  • Section-Level Briefings Delivered to an entire
    Section (e.g., the operational period briefing).

Photos courtesy of FEMA
79
ICS Briefings/Meetings
  • Essential to effective supervision and incident
    management
  • Clearly stated objectives
  • Short concise meetings, no long discussions or
    complex decision making
  • Allow manager or supervisor to pass along
    specific information and expectations for the
    upcoming work period and to field questions
    related to that information

Task
What is to be done?
Photos courtesy of FEMA
80
Operational Period Briefing (Shift briefing)
  • Conducted at the beginning of each operational
    period
  • Facilitated by the Planning Section Chief
  • Operations Briefing is held to introduce IAP to
    Branch Directors and Division/Group Supervisors
  • After the Operational Briefing, the Incident
    Action Plan is implemented

81
Schedule for Operations Briefing
  • Planning section chief reviews agenda and
    facilitates
  • ?
  • IC presents objectives (sometimes defers to
    Planning Chief to present)
  • ?
  • Off-going Operations Section Chief provides
    current assessment and
    accomplishments during last ops period
  • ?
  • Oncoming Operations Section Chief covers
    work assignments and staffing
  • ?
  • Technical Specialist -Safety Officer
    Special Operations present updates
  • ?
  • May have specific Unit Leaders present
    information
  • ?
  • Final IC comments
  • ?
  • Planning Section Chief announces next
    briefing time/location, adjourn

82
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
Photos courtesy of FEMA
83
IMS Feature Pre-designated Key Facilities and
Locations
  • 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
H-3
Photos courtesy of FEMA
84
IMS Features Summary
  • 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

85
4 Phases of Comprehensive Incident Management
(CEM) Activities for all hazard planning
Notification
Response
Preparedness
Recovery
Mitigation (Prevention)
Examples
  • Recovery
  • Return to pre-disaster state
  • Examples Repair/replacement of dike, damaged
    public facilities (bridges, schools, hospitals)
  • Debris cleanup removal
  • Temporary housing
  • Preparedness
  • Build response capacity/capability
  • Example buy dike plugs
  • Mitigation
  • (including prevention)
  • Prevention activities that reduce impact of
    hazard
  • Example build dikes to prevent flood
  • Conduct public health surveillance, testing
    immunizations and quarantine for biological
    threats
  • Response
  • Gain control of an event
  • Examples plug dike when a hole appears,
  • Emergency shelter, housing, food water
  • Search and rescue
  • Evacuation
  • Emergency medical services

NIMS slide adaptation
86
ICS Tools
  • Emergency Operations Plan
  • Hospital Policies and Procedures Manual
  • ICS Forms
  • Position Description and Job Action Sheets
  • Other resource materials

87
Are you Ready?
  • Are you now able to
  • Explain how the modular organization expands and
    contracts?
  • Given a scenario, recognize complicating factors?
  • Use a planning cycle?
  • Create an incident action plan?

88
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

89
Elective Slides
  • Volunteer groups that may be deployment during an
    incident

90
Categories of MN Emergency Readiness Volunteers
  • MN Disaster Medical Assistance Team (FEMA)
    http//www.mndmat.com/
  • Minnesota Responds/Medical Reserve Corp.
  • Community Emergency Response Teams (CERT)

91
Minnesota Responds
  • Pre-registers, manages and mobilizes volunteers
    to help communities respond to all types of
    disasters
  • Help communities cope up with medical and public
    health needs
  • Register through www.mnresponds.org
  • Volunteers attend a program orientation or
    training
  • Volunteers assigned according to training needs,
    profession, or skills
  • Anyone who has interest in volunteering during a
    health emergency is encouraged to register

92
Medical Reserve Corps (MRC)
  • There are 13 MRC Units throughout Minnesota
  • Apply through the
  • Minnesota Responds website
  • Or your local public health agency.
  • Your name will be stored in both the MN Responds
    and MRC databases
  • Many positions in Medical Reserve Corps do not
    require a license, training and experience more
    valuable
  • If licensed, Medical Reserve Corps staff will
    verify status of license with appropriate
    licensing board
  • Volunteers assist with public health initiatives
    community activities if there is no emergency
  • Volunteers work in mass dispensing or vaccination
    clinics, serve as staff at local hospital or
    off-site care facility and provide expert info.
    to local residents

93
Community Emergency Response Team (CERT)
  • Trained civilians to assist with emergency needs
    following a disaster
  • Training programs are offered within communities
    by first responders
  • Concepts covered are
  • Immediate needs following a disaster
  • Mitigation/preparedness activities
  • Life saving, decision-making skills,and rescuer
    safety
  • Offer immediate services until professional
    resources arrive

94
If you are assigned outside your facility
  • Assure that you have a sponsoring organization,
    travel, and housing
  • Authorization to leave, payroll, workers
    compensation issues
  • Personal and technical items packed (copies of
    licenses, etc)
  • Ensure that family knows where you will be and
    how you can be contacted
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