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Incident Management Systems for Hospitals

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Experts quoted in New York Times said 'no!' Lack of Benchmarks ... Unfolds in a modular fashion. Based on incident type and size ... – PowerPoint PPT presentation

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Title: Incident Management Systems for Hospitals


1
Incident Management Systems for Hospitals
  • Kristi L Koenig, MD, FACEP
  • Professor of Clinical Emergency Medicine
  • Director of Public Health Preparedness
  • University of California at Irvine

2
Why Management Aspects?
  • Incident Management new to health care systems
  • Not traditionally used in some types of events,
    e.g. biological, nursing strike
  • Clinical is relatively familiar
  • Emergency Management unfamiliar to most
    clinicians
  • ED is soft target

3
Are We Prepared?
  • Post 9/11
  • Prior Secretary of Department of Homeland
    Security said yes!
  • Experts quoted in New York Times said no!
  • Lack of Benchmarks

4
Why do hospitals need to be prepared?
  • Disaster are Local!
  • Most casualties arrive to the hospital within 1 ½
    hours
  • Civilian volunteers and local first responders
    rescue most victims
  • (95) within first 24 hours
  • Critical care and trauma surgery managed without
    State or Federal assistance

5
Disaster Casualties
  • Most planning focuses on injuries
  • Victims need treatment for other conditions
  • Lack of access to primary care
  • Exacerbation of chronic conditions
  • Psychological effects
  • Increased incidence of childbirth, heart attacks

6
Sudden Impact Events Study of 29 U.S. Disasters
  • Most trauma victims have minor injuries
  • Accidents occur during recovery phase
  • 10-15 of victims hospitalized
  • Half admitted for non-medical reasons
  • Sent home next day
  • 6 supply shortages
  • 2 personnel shortages

7
Lack of Resources?
  • Studies of recent disasters in the US show a lack
    of a management system to organize available
    resources
  • Hurricane Katrina
  • An exception?

8
Key Principles
  • All-Hazard
  • Hazards Vulnerability Analysis (HVA)
  • Comprehensive Emergency Management
  • Mitigation
  • Preparedness
  • Response
  • Recovery
  • Incident Management System

9
Why Incident Management Systems for Hospitals?
  • Continuity of Business Operations Plan
  • Meet responsibilities to employees, patients, and
    community
  • Reduce insurance/workers compensation costs
  • Protect capital investment
  • Regulatory compliance
  • Ultimate goal to reduce morbidity and mortality
  • JCAHO requirement

10
JCAHO Requirements January 2001
  • All-Hazard
  • Hazard Vulnerability Analysis (HVA)
  • Comprehensive Emergency Management
  • Community-Wide Planning
  • Incident Management System
  • Example - Hospital Emergency Incident Command
    System (HEICS)
  • Consistent with community standards

11
Incident Management System
  • Command, Control, Leadership
  • Flexible process for ongoing assessment
  • Incident Action Plans
  • Unified Command for multi-jurisdictional events
  • Federal Level
  • National Incident Management System (NIMS)
  • Hospital Level
  • Hospital Emergency Incident Command System
    (HEICS)
  • Change to Hospital Incident Command System (HICS)

12
Disaster Management Agencies Federal
Structure Pre 9/11
13
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

14
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

15
External Scenarios
  • Nuclear Detonation10-Kiloton Improvised Nuclear
    Device
  • Biological AttackAerosol Anthrax
  • Biological Disease OutbreakPandemic Influenza
  • Biological AttackPlague
  • Chemical AttackBlister Agent
  • Chemical AttackToxic Industrial Chemicals
  • Chemical AttackNerve Agent
  • Chemical AttackChlorine Tank Explosion
  • Natural DisasterMajor Earthquake
  • Natural DisasterMajor Hurricane
  • Radiological AttackRadiological Dispersal
    Devices
  • Explosives AttackBomb Using Improvised Explosive
    Device
  • Biological AttackFood Contamination
  • Cyber Attack

16
Internal Scenarios
  • Bomb Threat
  • Evacuation, Complete or Partial Facility
  • Fire
  • Hazardous Material Spill
  • Hospital Overload
  • Hostage/Barricade
  • Infant/Child Abduction
  • Internal Flooding
  • Loss of Heating/Ventilation/Air Conditioning
  • Loss of Power
  • Loss of Water
  • Severe Weather
  • Work Stoppage

17
ICS - Components
  • Adaptable to any type of emergency
  • Common organizational/procedural standards
  • Common Terminology
  • Integrated Communications
  • Modular Organization
  • Unified Command Structure
  • Maintains autonomy of jurisdiction

18
ICS - Components
  • Manageable Span of Control
  • Consolidated Action Plans
  • Represent Incident Action Planning Process
  • Comprehensive Resource Management
  • Designated Incident Facilities

19
ICS 5 Major Functional Areas
  • Command or Management
  • Operations
  • Planning
  • Logistics
  • Finance

20
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21
Health Care Facilities
  • Victims arrive unannounced
  • May not arrive by EMS
  • Family and friends overwhelm system with
    inquiries
  • Volunteers
  • Media

22
Health Care Facilities
  • Convergence of injured persons, relatives
    friends, the general public (volunteers),
    off-duty staff medical personnel, and media
  • Not a Scarcity of Resources
  • Lack of Incident Management System

23
Critical Hospital Resources
  • Physical plant
  • Personnel
  • Supervision
  • Supplies and Equipment
  • Communication
  • Transportation

24
Brief History of HEICS
  • 1980s FIRESCOPE
  • Southern California wildfires use ICS
  • 1987 - Hospital Council of Northern California
    adapts ICS to hospitals
  • 1991 - HEICS I
  • 1992/93 HEICS II
  • 1998- HEICS III
  • 2006- HEICS IV
  • August 2006- HICS Guidebook

25
HEICS I - III
  • Areas needing improvement
  • Not NIMS compliant
  • Medical Officer not directly under IC
  • Labor pool in Planning, not Operations
  • Damage assessment in Logistics, not Operations
  • Operations section
  • Only focus on medical requirements
  • Designed around department, not incident
    functions
  • No concept of Incident Action Planning
  • Existed separately from hospital disaster plan

26
The New HICS
  • HEICS IV/HICS has different organizational chart
  • Simpler and smaller
  • More flexible and adaptable
  • NIMS compliant
  • Enhanced Job Action Sheets
  • Extended operations and recovery sections

27
HICS Guidebook
  • 1 High-level guidance for developing a
    hospital Emergency Management Program (EMP)
  • Key considerations
  • Planning and response assumptions
  • Provides guidance for use of the incident command
    system
  • Adapted to incident specific situations
  • Modular and scalable based on availability of
    personnel

28
HICS Guidebook
  • 2 A HICS training curriculum
  • Specific instructional guidance and teaching
    outlines
  • Curriculum materials designed to provide variable
    methods of training hospital staff
  • Emergency response principles
  • Incident command

29
New HICS Elements
  • A more compact and versatile incident management
    team structure
  • Modular
  • Scalable to the event
  • Updated Job Action Sheets (JAS)
  • Revised, National Incident Management System
    (NIMS) consistent forms

30
New HICS Elements
  • Incident Planning Guides (IPG)
  • Assist in evaluating and writing emergency plans
  • Scenario based
  • Incident Response Guides (IRG)
  • Key considerations and response actions for
    command staff
  • Scenario based
  • Expanded information and tools
  • Guidebook and Appendices
  • Resources

31
HICS Summary
  • The HEICS IV/HICS project updated HEICS III to
    current emergency management practices and
    principles
  • Developed by hospital and incident command
    experts
  • HICS Guidebook assists hospitals in
    implementation
  • HICS provides new materials
  • Job Action Sheets
  • Incident Planning Guides
  • Incident Response Guides

32
Hospital ICS
33
Command Section
  • Leadership
  • Incident Commander
  • Organize and direct Emergency Operations Center
    and all positions throughout the ICS structure
  • Overall direction for hospital operations
  • Authorizes evacuations

34
Command (Management) Section
  • Responsible for overall incident management
  • Command Staff Positions
  • Information (Public Affairs) Officer
  • Safety Officer
  • Liaison Officer
  • Single vs. Unified Command

35
Operations Section
  • Reduction of immediate hazard
  • Establish situation control
  • Restore normal operations
  • Functions
  • Staging areas
  • Resources
  • Organization of operations divisions, groups, and
    branches

36
Operations Section Key Components
  • Business Continuity
  • Equipment
  • Plant and Utilities
  • Safety and Security
  • Health and Medical

37
Planning Section
  • Collection, evaluation and dissemination of
    tactical information about the incident
  • Maintains information on current and forecasted
    situation
  • Tracks status of resources
  • Primary units
  • Section chief/deputy, resources unit, situation
    unit, documentation unit, demobilization unit,
    technical specialists

38
Logistics Section
  • Provide support to incident
  • Order all resources from off-incident locations
  • Provide facilities, transportation, supplies,
    equipment maintenance, fueling, feeding,
    communication and medical services for responders
  • Sections
  • Chief/deputy, supply unit, facilities unit,
    ground support/transportation unit

39
Finance Section
  • Procurement Unit
  • Time Unit
  • Compensation/Claims Unit
  • Cost Unit
  • Capture costs for FEMA reimbursements during
    State or Federal disaster declarations

40
ICS Translated!
  • Command/Management…Pointers
  • Plans………………………Thinkers
  • Logistics…………………..Getters
  • Finance……………………Counters
  • Operations………………...Doers

41
ICS Functional Responsibility
  • Command
  • Strategy, global responsibility
  • Define mission, ensure completion
  • Operations
  • Implement plan, direct tactics
  • Planning
  • Collect/analyze data, direct planning
  • Continuity of operations
  • Logistics
  • Support response
  • Environment and materials
  • Finance
  • Track money, ensure documentation
  • Maximize recovery, reduce liability

42
ICS Implementation
  • Unfolds in a modular fashion
  • Based on incident type and size
  • Single individual can simultaneously manage all
    major functional areas or independent management
    required
  • Used to plan, organize, staff, direct and control
    emergency situations

43
ICS Implementation
  • Incidents without warning (earthquake, explosion)
  • Leadership and direction initially provided by
    any employee who first recognizes the danger
  • Incidents with warning (severe weather, cloud of
    hazardous materials approaching facility)
  • Director or designee provides initial leadership
    and direction

44
ICS Implementation Incident Management Team
45
Command Post
  • Consider establishing for incident that involves
    a distinct scene within the facility or its
    grounds
  • Ad-hoc location where decisions are made
    concerning control of incident

46
Emergency Operations Center
  • Pre-designated location within facility
  • Location where activates related to information
    collection, inter-service coordination, strategic
    decision-making and resource allocation are
    managed
  • Not all incidents require the use of an EOC

47
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48
EOC Activities
  • Gather information through ongoing assessments
  • Brief EOC staff
  • Establish shifts
  • Set overall objectives for each shift
  • Determine resource requirements
  • Develop communications and traffic plans
  • Keep complete documentation

49
Life Cycle of an Incident
  • Event recognition
  • Incident notification
  • Situation analysis and monitoring
  • Emergency Operations Plan (EOP) activation
  • Operation of the Hospital Command Center (HCC)
  • Staffing the Incident Management Team
  • Incident Action Planning
  • Communication and Coordination
  • Demobilization
  • System Recovery

50
Its 3 a.m. and Disaster Strikes…
  • Response Actions
  • Control the scene
  • Establish a Command Post
  • Conduct internal notifications
  • Develop initial strategy for protecting life and
    property
  • Determine what resources are needed to control
    the problem
  • Continue to organize and manage the situation
    until relieved

51
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
52
Summary Hospital ICS
  • All Hazard
  • Hazard Vulnerability Analysis
  • Comprehensive Emergency Management
  • Convergence at hospitals
  • Need for management system, not just resources
  • Function based
  • Command Plans, Logistics, Finance, Operations

53
References
  • VA Emergency Management Program Guidebook
    (updated 6/28/05)
  • http//www1.va.gov/emshg/page.cfm?pg114
  • Emergency Management Principles and Practices for
    Healthcare Systems
  • http//www.va.gov/emshg
  • California EMS Authority
  • http//www.emsa.ca.gov/hics/hics.asp
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