Understanding the Incident Command System ICS Manuel M' Fontes, MA Research Specialist Yvette M' Cor

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Understanding the Incident Command System (ICS)
Manuel M. Fontes, MAResearch
SpecialistYvette M. Corral, BSInstructional
Specialist Coordinator
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• This workshop was supported by Grant
  U90/CCU924239-02 from the CDC. Its contents are
  solely the responsibility of the authors
  and do not necessarily represent the
  views of the CDC

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History of the Incident Command System (ICS)

• The Incident Command System commonly known as
  ICS was first developed during the 1970s in
  California.
• It was developed primarily as a standardized
  management tool to meet the demands of small and
  large-scale emergencies.
• However, it is not limited to fighting fires and
  can be used to manage any planned event.

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The Incident Command System as a Management Tool

• The Incident Command System is not limited to
  only fighting fires.
• The Incident Command System (ICS) was created by
  using sound business practices.
• Studies have shown that inadequate management is
  the single reason why projects fail.

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Why the Incident Command System is Used in
Public Health

• Since September 11th, 2001, public health has
  been required to respond to a variety of small to
  complex incidents, both natural and manmade.
• The Incident Command System (ICS) provides a
  common management system to handle public health
  emergencies at all levels of the government
  Federal, Tribal, State and County.

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Chain-of-Command

• Information must be directed from the top to the
  bottom and from the bottom to the top.

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Unity-of-Command

• Unity-of-Command means every individual within
  the Incident Command System (ICS) has only one
  designated supervisor to whom he or she reports
  to.

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Public Health Aspects of Natural Disasters
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Learning Objectives

• Identify different types of natural disasters and
  the six categories of public health interventions
  in a disaster
• Define Public Healths role during an event

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What is a Natural Disaster?

• Result of a vast ecological breakdown in the
  relation between humans and their environment
• Serious and sudden or can be slow
• Community needs extraordinary efforts to cope

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Examples of Natural Disasters

• Flood
• Wildfires
• Extreme Heat
• Landslides Mudslides
• Tornado
• Tsunami

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Public Health Interventions in a Disaster

• Goal is to safeguard the population from disease
  related to
• Sanitation
• Personal hygiene
• Water supply
• Diarrheal disease
• Heating and shelter
• Mental Health

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Your Community

• How have your communities reacted to the natural
  disaster aftermath?

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The Need for Public Health Preparedness

• The possibility of public health emergencies
  arising in the United States concerns many people
  in the wake of recent hurricanes, tsunamis, acts
  of terrorism, and the threat of pandemic
  influenza. Though some people feel it is
  impossible to be prepared for unexpected events,
  the truth is that taking preparedness actions
  helps people deal with disasters of all sorts
  much more effectively when they do occur.
  Centers for Disease Control and Prevention

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What is Public Health Preparedness?

• Planning, Planning, Planning!!
• Training and Education
• Engaging community partners in discussion of
  their needs
• Addressing the challenges of special needs
  populations
• Creating partnerships across various agencies and
  jurisdictions

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What Types of Events would Public Health Respond
to?

• Infectious Disease Outbreaks
• Wild Land Fires
• Terrorism or Bioterrorism Events
• Environmental Disasters
• Large-scale Industrial Accidents
• Natural Disasters
• Mass Casualties

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Public Healths Role During an Event

• Activate emergency response plan
• Road map of when and how to respond
• Deploy personnel
• Trained persons to a command center
• Evaluate information
• Agencies can conduct epi investigations or
  enhanced surveillance
• Invoke public health emergency powers
• Mandatory testing reporting procedures

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Public Healths Role During an Event cont.

• Coordinate medical services
• Overflow to other treatment facilities
• Monitor requests for support
• More equipment, supplies, or personnel
• Deactivate emergency response plan
• Depends on the level of threat remaining

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Stages Surrounding an Event
EVENT
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What Agencies Does Public Health Partner With?

• Emergency Management, FEMA
• Law Enforcement, Fire Department, National Guard
• EMS, Red Cross, health care providers, hospitals
• Medical examiners
• Mental health agencies and providers
• Clinical labs, Public health labs
• Environmental and Agricultural agencies
• Department of Public Works
• Tribal Counter-Parts

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Lets Practice
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Scenario

• On July 28, 2008 a call comes in to the Tribal
  Health Department regarding an outbreak of
  Hepatitis-A on the reservation. Several people
  have been taken to the tribal hospital with
  symptoms of Hepatitis-A. Tribal health officials
  decide that public health staff will be assigned
  responsibilities according to the Incident
  Command System (ICS). This decision is made to
  organize the health departments emergency
  response efforts to locate the source of the
  disease and look for others that may be in danger
  of getting sick.

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The Tribal Health Department
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Problem 1

• The local newspaper calls and wants to know what
  is going on. Who should handle this problem?

The Public Information Officer (PIO)
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Problem 2

• The Tribal Health Department needs to send out
  people to investigate the problem. Families need
  to be interviewed in order to find out if anyone
  is getting sick. Who should handle this problem?

The Operations Section
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Problem 3

• The Tribal Health Department needs to pay for
  medical supplies for families in need. Who
  should handle this problem?

The Finance/Administration Section
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Problem 4

• A decision needs to be made regarding calling in
  more people to help with interviewing families.
  Who should handle this problem?

The Incident Commander
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Problem 5

• The County Health Department calls to see if they
  can assist in finding any enrolled members that
  live off the reservation. Who should handle this
  problem?

The Liaison Officer
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Problem 6

• More tribal health personnel need to be called in
  to help with the situation. Who should handle
  this problem?

The Logistics Section
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Problem 7

• A plan needs to be developed in order to best
  find families in the villages. Who should handle
  this problem?

The Planning Section
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Problem 8

• It is believed that some of the procedures that
  are being used in the field might put Tribal
  Health Department employees at risk of being
  exposed to Hepatitis-A. The procedures need to
  be stopped. Who should handle this problem?

The Safety Officer
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Community Health Representatives Role in a
Public Health Event
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Learning Objectives

• Explain what an outbreak is and the steps taken
  in an outbreak investigation
• Explain the difference between disease
  surveillance and outbreak investigation

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What is an Outbreak?

• A sudden rise in the incidence of a disease
• Clinician, infection control nurse, or clinical
  laboratory worker first notices an unusual
  disease or an unusual number of cases of a
  disease and alerts public health officials

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Outbreak Investigations

• Help identify the source of ongoing outbreaks and
  prevent additional cases
• Thorough investigations often can increase
  knowledge of a given disease and prevent future
  outbreaks
• Infectious disease outbreak investigations are
  initiated and conducted at the local level
• Local health departments are responsible for all
  of the steps of an outbreak investigation and
  work with larger state or federal agencies during
  large-scale events

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Why is there a need to Investigate Outbreaks?

• Control and Prevention
• Research Opportunities
• Training
• Public, Political, or Legal Concerns

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Outbreak Investigation Steps

• Verify the diagnosis and confirm the outbreak
• Confirm laboratory testing
• Rule out misdiagnoses or laboratory error
• Define a case and conduct case findings
• Develop a specific case definition using
• Symptoms or laboratory results
• Time period
• Location
• Conduct surveillance using case definition
• Existing surveillance
• Active surveillance (e.g. review medical records)
• Interview case patients

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Outbreak Investigation Steps Cont.

• Count/record and orient data time, place, person
• Create line listing (case plotted on a graph)
• Person
• Who was Infected?
• What do the cases have in common?
• Place
• Where were they infected?
• May be useful to draw a map
• Time
• When were they infected?
• Create an epidemic curve

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Outbreak Investigation Steps Cont.

• Take immediate control measures
• If an obvious source of contamination is
  identifiedinstitute control measures
  immediately!
• Formulate and test hypothesis
• Develop hypothesis
• Literature reviews of previous outbreaks
• Interviews of several case-patients
• Conduct an analytic study to test hypotheses
• Retrospective cohort study
• Case-control study

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Outbreak Investigation Steps Cont.

• Plan and execute additional studies
• Environmental sampling
• Collect appropriate samples
• Allow epidemiological data to guide testing
• If analytic study results are conclusive, dont
  wait for positive samples before implementing
  prevention
• Implement and evaluate control measures
• Prevent further exposure and future outbreaks by
  eliminating or treating the source
• Work with regulators, industry, and health
  educators to institute measures
• Create mechanism to evaluate both short- and
  long-term success

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Outbreak Investigation Steps Cont.

• Communicate finding
• Identify a single member of the investigation
  team to interact with media and communicate
  progress and findings
• Summarize investigation, make recommendations,
  and disseminate report to all participants

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Partnering with an Epidemiologist

• Case interviewing and data collection
• Data entry and analysis
• Case contact tracing and identification
• Case follow-up

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The Importance of Surveillance/Detection

• Goal Detect unusual medical events sooner rather
  than later
• Depends on ability to identify a greater than
  expected number of cases or syndromes (disease)

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Stages Surrounding an Event
EVENT
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The Role of a Community Health Representative in
Response and Mitigation

• Search and Rescue
• Transportation Services

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The Role of a Community Health representative in
Recovery

• Advocate for the health needs of the community
• Health Educator

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The Role of a Community Health Representative in
Preparedness

• Health Educator
• Data Entry

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Scenario

• At 1005 a.m. today, a flood hit your community.
  People have reported damage to homes, and
  businesses have been affected as well. No
  fatalities have been reported. Three people with
  injuries have been taken to the Community
  Hospital, which is also reporting some damage. As
  many as 10 people are missing. Many houses are
  destroyed and shelters will be needed. Utility
  lines are down and a major road has been
  affected.

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Case Study
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Group Tasks

• You will form 2 small groups to address the
  general problem of your case study we will report
  back to the larger group in 15 minutes.

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Personal Preparedness Planning
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Basic Principles of Personal Preparedness

• All of us should be able to survive comfortably
  on our own for at least 3 days following an
  incident
• The time to prepare is before an incident occurs
• Participate in open discussion with family
  members about response planning

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Types of Events to Prepare for

• Natural Disasters
• Hurricanes, Earthquakes, Floods
• Naturally Occurring Illnesses
• Influenza, SARS
• Terrorism Events
• Chemical, Biological, Radiological, Nuclear and
  Explosive

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Basic Categories of Items For an Emergency Kit
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Water

• The average person uses one gallon of water per
  day in drinking, cooking, and miscellaneous uses
• A 3 7 day supply is recommended
• Store water in sealed, unbreakable containers
• If bottling your own water, note storage date and
  replace every 6 months
• If purchasing bottled water, follow the
  expiration date on the bottle

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Food

• Non-perishable foods
• 3 7 day supply is recommended
• Maintain caloric intake
• Minimize the use of food that requires
  preparation
• Have a manual can opener
• Maintain sanitation by using fresh water for
  cooking

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Shelter

• Use blankets/sleeping bags for warmth
• Pillow
• Small candle
• Waterproof matches

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Clothing

• Change of clothes
• Comfortable shoes, socks
• Layers of clothing for comfort
• Raincoat or poncho
• Hat

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Basic Supplies

• Personal medications (at least a 3-day supply)
• Battery-powered flashlight
• Spare batteries
• Pan for cooking
• Communication/battery-powered radio
• First aid kit
• Map
• Knife/utensils

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Personal Hygiene

• Bathroom tissue
• Deodorant
• Feminine products
• Soap
• Hand-washing materials
• Sunscreen

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Additional Key Items

• Cash and credit cards
• Personal identification
• Extra set of car keys
• Extra eyeglasses, contact lenses
• Scissors
• Duct-tape/heavy-duty garbage bags

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Family Communication Plan
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Family Awareness

• Your family may not be together when disaster
  strikes, so plan how you will contact one another
  and review what you will do in different
  situations

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Plan

• Following information should be kept up to date
  on each family member
• Name
• Date of Birth
• Social Security Number
• Important Medical Information

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Where to go in an Emergency

• Write down where your family spends the most
  time
• Work
• School
• Other places you frequent
• Schools, daycare providers, workplaces and
  apartment buildings should all have site-specific
  emergency plans