ICS Review & Response


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Overview of ICS and hospital response measures

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  • Gathering information to compare ICS vs Other response methods.
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  • ICS began out of necessity in the 1970’s when several wildfires in California caused millions in damage and several people died. Local, state and federal fire authorities collaborated to form FIRESCOPE (Firefighting Resources of California Organized for Potential Emergencies). FIRESCOPE looked at recent wildfire responses, and discovered that poor incident management was to blame, not a lack of resources. Problems that were identified were: Nonstandard terminology Lack of organizational flexibility to expand and contract Nonstandard and nonintegrated communications Lack of consolidated action plans Lack of designated facilities ICS was developed to overcome these 5 problems. Today, incidents demand so many resources and skills that one local, state or federal agency couldn't possibly provide them, so ICS provides a way for many agencies to work together smoothly under one management system.
  • Common Terminology Incident Commander, Chain of Command, Staging Area Flexible and Modular organization Incident Command structure is organized in such a way as to expand and contract as needed by the incident scope, resources and hazards. Command is established in a top-down fashion, with the most important and authoritative positions established first. For example, Incident Command is established by the first arriving unit. Unity of command Each individual participating in the operation reports to only one supervisor. This eliminates the potential for individuals to receive conflicting orders from a variety of supervisors, thus increasing accountability, preventing freelancing, improving the flow of information, helping with the coordination of operational efforts, and enhancing operational safety. This concept is fundamental to the ICS chain of command structure Unified Command Incident Commanders representing agencies or jurisdictions that share responsibility for the incident manage the response from a single Incident Command Post
  • Every incident requires a certain number of incident functions to be performed The problem must be identified and assessed A plan must be developed and implemented The necessary resources must be provided
  • Span of control is extremely important in incidents or events where safety and accountability are top priorities
  • Understand the Emergency Operation Plan
  • Manage High profile surgeries, parades, weddings, or terrorism Clear chain of command means wearing your ICS vest Eliminates duplication by assigning roles with job action sheets
  • History tells us that 80% - 85% of trauma patients will walk, take a car or taxi to the nearest hospital. They will not wait for an ambulance. Tokyo – Subway OK, City – Bombing Madrid Spain – Train bombing Russia - Subway
  • The hospital may become part of the crime scene. In the case of an intentional explosion, the patients are witnesses and may have parts of the bomb material on their clothes which is evidence. The hospital will be full of police, FBI, ATF and other officers
  • Simple to complex. Code blue called in the electrical room in post-op. On arrival you find 5 adult men have been electrocuted.
  • What do we want to do? Who is going to do it? How will we communicate?
  • ICS Review & Response

    1. 1. Review of the Incident Command System & Response Measures David Wood, Safety/Emergency Management Officer Cook Children’s Northeast Hospital August 2010
    2. 2. Objectives <ul><li>Develop a basic understanding of the Incident Command System </li></ul><ul><li>Be able to write an Incident Action Plan </li></ul><ul><li>Be able to describe the Incident Notification Process </li></ul><ul><li>Be able to distinguish between internal and external Situation Analysis and Monitoring </li></ul><ul><li>Establish Immediate Response Measures </li></ul>
    3. 3. What is the Incident Command System (ICS)? <ul><li>ICS (Incident Command System) </li></ul><ul><ul><li>Is a standardized, on-scene all-hazard incident management concept </li></ul></ul><ul><ul><li>Allows its users to adopt an integrated organizational structure </li></ul></ul><ul><ul><ul><li>Matching the complexities and demands of single or multiple incidents </li></ul></ul></ul><ul><ul><ul><li>Not hindered by jurisdictional boundaries </li></ul></ul></ul>
    4. 4. Purpose of ICS <ul><li>Using best practices, ICS ensures </li></ul><ul><ul><li>Safety of responders and others </li></ul></ul><ul><ul><li>Achievement of tactical objectives </li></ul></ul><ul><ul><li>Efficient use of resources </li></ul></ul>
    5. 5. Basic Features of ICS <ul><li>Common terminology </li></ul><ul><li>Modular organization </li></ul><ul><li>Management by objectives </li></ul><ul><li>Reliance on an Incident Action Plan (IAP) </li></ul><ul><li>Chain of command and unity of command </li></ul><ul><li>Unified Command </li></ul><ul><li>Manageable span of control </li></ul>
    6. 6. ICS Management Functions <ul><li>Five management functions </li></ul><ul><ul><li>Command </li></ul></ul><ul><ul><li>Operations </li></ul></ul><ul><ul><li>Planning </li></ul></ul><ul><ul><li>Logistics </li></ul></ul><ul><ul><li>Finance/Administration </li></ul></ul>Incident Commander Operations Chief Planning Chief Logistics Chief PIO Safety Officer Liaison Officer Technical Specialist Finance/Admin Chief
    7. 7. ICS Management: Command <ul><li>Command </li></ul><ul><ul><li>Sets the objectives </li></ul></ul><ul><ul><li>Devises strategies and priorities </li></ul></ul><ul><ul><li>Maintains overall responsibility for managing the incident </li></ul></ul><ul><li>The Incident Commander </li></ul><ul><ul><li>Is the only position always filled during an incident regardless of its nature </li></ul></ul><ul><ul><li>May be able to accomplish all five management functions alone on small scale incidents </li></ul></ul><ul><ul><li>On larger incidents effective management may require that each function be established as a separate Section </li></ul></ul>
    8. 8. ICS Command Staff <ul><li>The Command Staff include: </li></ul><ul><ul><li>Public Information Officer </li></ul></ul><ul><ul><li>Safety Officer </li></ul></ul><ul><ul><li>Liaison Officer </li></ul></ul><ul><ul><li>Technical Specialist </li></ul></ul><ul><ul><ul><li>Chemical </li></ul></ul></ul><ul><ul><ul><li>Biological – Infectious Disease </li></ul></ul></ul><ul><ul><ul><li>Medical Ethicist </li></ul></ul></ul><ul><ul><ul><li>Legal </li></ul></ul></ul>
    9. 9. ICS Command Staff <ul><li>Public Information Officer </li></ul><ul><ul><li>Advises the Incident Commander on information dissemination and media relations </li></ul></ul><ul><ul><li>Obtains information from and provides information to the Planning Section </li></ul></ul><ul><ul><li>Obtains information from and provides information to the community and media </li></ul></ul><ul><li>Safety Officer </li></ul><ul><ul><li>Advises the Incident Commander on issues regarding incident safety </li></ul></ul><ul><ul><li>Works with the Operations Section to ensure the safety of field personnel </li></ul></ul><ul><ul><li>Ensures safety of all incident personnel </li></ul></ul>
    10. 10. ICS Command Staff <ul><li>Liaison Officer </li></ul><ul><ul><li>Serves as a point of contact for agency representatives supporting the operations </li></ul></ul><ul><ul><li>Provides briefings to and answers questions from supporting agencies </li></ul></ul>
    11. 11. ICS Command Staff <ul><li>Technical Specialist </li></ul><ul><ul><li>Specialist is different areas that provide technical information to the incident commander </li></ul></ul><ul><ul><ul><li>Biological – Infectious disease </li></ul></ul></ul><ul><ul><ul><li>Chemical </li></ul></ul></ul><ul><ul><ul><li>Legal </li></ul></ul></ul><ul><ul><ul><li>Radiological </li></ul></ul></ul><ul><ul><ul><li>Medical Ethics </li></ul></ul></ul><ul><ul><ul><li>Communications </li></ul></ul></ul><ul><ul><ul><li>Mass Casualty Management </li></ul></ul></ul>
    12. 12. ICS Management: Operations <ul><li>Operations </li></ul><ul><ul><li>Conducts the tactical operations </li></ul></ul><ul><ul><li>Carries out the plan using defined objectives </li></ul></ul><ul><ul><li>Directs all needed resources </li></ul></ul>
    13. 13. ICS Management: Planning <ul><li>Planning </li></ul><ul><ul><li>Collects and evaluates information for decision support </li></ul></ul><ul><ul><li>Maintains resource status </li></ul></ul><ul><ul><li>Prepares documents such as the Incident Action Plan </li></ul></ul><ul><ul><li>Maintains documentation for incident reports </li></ul></ul>
    14. 14. ICS Management: Logistics and Finance/Administration <ul><li>Logistics </li></ul><ul><ul><li>Provides support, resources, and other essential services to meet the operational objectives </li></ul></ul><ul><li>Finance/Administration </li></ul><ul><ul><li>Monitors costs related to the incident </li></ul></ul><ul><ul><li>Provides accounting, procurement, time recording, and cost analyses </li></ul></ul>
    15. 15. Span of Control <ul><li>Refers to the number of individuals that one person can effectively manage </li></ul><ul><li>Effective span of control ranges from 3 to 7 reporting elements per supervisor </li></ul><ul><li>If the number of reporting elements is not within this range, expansion or consolidation of the organization may be needed </li></ul>
    16. 16. The Incident Planning Process <ul><li>Six Steps in Incident Planning </li></ul><ul><ul><li>Understanding policy and direction </li></ul></ul><ul><ul><li>Assessing the situation </li></ul></ul><ul><ul><li>Establishing incident objectives </li></ul></ul><ul><ul><li>Determining appropriate strategies to achieve the objectives </li></ul></ul>
    17. 17. <ul><li>Six Steps in Incident Planning </li></ul><ul><ul><li>Providing tactical direction and ensuring that it is followed </li></ul></ul><ul><ul><ul><li>Example: The correct resources assigned to complete a task and their performance monitored </li></ul></ul></ul><ul><ul><li>Providing necessary back-up </li></ul></ul><ul><ul><ul><li>Assigning more or fewer resources </li></ul></ul></ul><ul><ul><ul><li>Changing tactics </li></ul></ul></ul>The Incident Planning Process
    18. 18. Key Points <ul><li>Benefits of ICS are: </li></ul><ul><ul><li>Manages routine or planned events </li></ul></ul><ul><ul><li>Establishes a clear chain of command </li></ul></ul><ul><ul><li>Provides a a common structure </li></ul></ul><ul><ul><li>Provides logistical and administrative support to operational personnel </li></ul></ul><ul><ul><li>Ensures key functions are covered and eliminates duplication </li></ul></ul>
    19. 19. Key Points <ul><li>ICS is modular and scalable to the scope and magnitude of the incident </li></ul><ul><ul><li>Incident Commander always activated </li></ul></ul><ul><ul><li>Other positions activated as needed </li></ul></ul><ul><li>There are five management functions </li></ul><ul><ul><li>Command </li></ul></ul><ul><ul><li>Operations </li></ul></ul><ul><ul><li>Planning </li></ul></ul><ul><ul><li>Logistics </li></ul></ul><ul><ul><li>Finance/Administration </li></ul></ul>
    20. 20. Key Points <ul><li>ICS provides a common terminology and position titles to enhance standardization among agencies and responders </li></ul><ul><ul><li>Fire </li></ul></ul><ul><ul><li>Police </li></ul></ul><ul><ul><li>FBI </li></ul></ul><ul><ul><li>ATF </li></ul></ul><ul><ul><li>CDC </li></ul></ul>
    21. 21. Incident Notification <ul><li>An incident is </li></ul><ul><ul><li>An emergent event that disrupts or threatens to disrupt normal operations </li></ul></ul><ul><ul><li>A planned event in the hospital or community </li></ul></ul><ul><ul><li>Notification may come from </li></ul></ul><ul><ul><ul><li>Law Enforcement </li></ul></ul></ul><ul><ul><ul><li>Radio or Television </li></ul></ul></ul><ul><ul><ul><li>Weather forecast </li></ul></ul></ul><ul><ul><ul><li>Public </li></ul></ul></ul><ul><ul><ul><li>Emergency Management </li></ul></ul></ul>
    22. 22. Incident Notification <ul><li>Notification </li></ul><ul><ul><li>Communication to relevant personnel of important information regarding an actual or potential hazard impact and the response status of the organization </li></ul></ul><ul><li>Categories </li></ul><ul><ul><li>Advisory: Potential need for a response </li></ul></ul><ul><ul><li>Alert: Elevated preparedness required as response is likely or imminent </li></ul></ul><ul><ul><li>Activation: Response action is required </li></ul></ul>
    23. 23. Incident Notification <ul><li>Critical information to obtain </li></ul><ul><ul><li>Type of incident, including specific hazard/agent </li></ul></ul><ul><ul><li>Location of incident </li></ul></ul><ul><ul><li>Numbers and types of injuries </li></ul></ul><ul><ul><li>Special actions being taken (e.g., decontamination) </li></ul></ul><ul><ul><li>Estimated time of arrival of first EMS units/Walk-ins </li></ul></ul><ul><ul><li>Walk in patients may be your first notification </li></ul></ul>
    24. 24. Incident Notification <ul><li>Response </li></ul><ul><ul><li>Measures to protect safety </li></ul></ul><ul><ul><li>Timely notification of incident management personnel via multiple communication systems </li></ul></ul><ul><ul><li>For incidents recognized by hospital, notification of appropriate external agencies, such as </li></ul></ul><ul><ul><ul><li>Law Enforcement </li></ul></ul></ul><ul><ul><ul><li>Fire/EMS </li></ul></ul></ul><ul><ul><li>Requires planning and staff training on procedures, to include after-hours contact information for key personnel </li></ul></ul>
    25. 25. Situation Analysis and Monitoring <ul><li>Sources of external situation information </li></ul><ul><ul><li>EMS: incident reports by radio or telephone, personnel </li></ul></ul><ul><ul><li>Patients </li></ul></ul><ul><ul><li>Law Enforcement </li></ul></ul><ul><ul><li>Health and Medical Services (ESF 8) in local Emergency Operations Center (EOC) </li></ul></ul><ul><ul><li>On-scene Incident Command Post </li></ul></ul><ul><ul><li>Local and national media </li></ul></ul>
    26. 26. Situation Analysis and Monitoring <ul><li>Sources of internal situation information </li></ul><ul><ul><li>Periodic updates from incident management team members, as scheduled or as situation warrants </li></ul></ul><ul><ul><li>Tours of affected areas within facility </li></ul></ul><ul><ul><li>Real-time or recorded surveillance of critical areas </li></ul></ul>
    27. 27. Simple Incidents <ul><li>Occur frequently </li></ul><ul><li>Routinely handled </li></ul><ul><li>Require few resources </li></ul><ul><li>Have “limited” command structure </li></ul><ul><li>Relatively short duration </li></ul>Simple Incidents Normal Influenza season Busy, but manageable patient load
    28. 28. Complex Incidents <ul><li>May start as complex or become complex </li></ul><ul><li>Prolonged duration </li></ul><ul><li>Requires large number of resources </li></ul><ul><li>High risk to staff/facility </li></ul><ul><li>More complex management structure </li></ul><ul><li>Necessitates formal planning </li></ul>Complex Incidents Natural disaster - Tornado Mass-casualty Terrorism
    29. 29. Incident Action Plan (IAP) <ul><li>Every incident should have an IAP </li></ul><ul><ul><li>May be spoken or written </li></ul></ul><ul><ul><li>Should cover one (1) operational period – Time of incident until relived of command (approx 2 hours) </li></ul></ul><ul><li>Incident complexity dictates the detail of the IAP </li></ul><ul><ul><li>Spoken IAP is usually sufficient in simple incidents </li></ul></ul><ul><ul><li>Complex incidents should have a written IAP </li></ul></ul>
    30. 30. Establishing an IAP <ul><li>Management of an incident begins with a basic oral IAP quickly put in place </li></ul><ul><li>At a minimum covers: </li></ul><ul><ul><li>The objectives to be achieved </li></ul></ul><ul><ul><li>What it is we want/need to accomplish </li></ul></ul><ul><li>The strategies/tactics to be used to achieve the objectives safely </li></ul><ul><ul><li>How can we accomplish the objectives? </li></ul></ul>
    31. 32. Response Measures <ul><li>Gather as much information as possible </li></ul><ul><ul><li>What impact could this event have </li></ul></ul><ul><ul><li>Prepare for worse case scenario </li></ul></ul><ul><li>Establish Incident Action Plan (IAP) </li></ul><ul><li>Contact AOC and, if needed local authorities </li></ul><ul><li>Maintain overall responsibility for managing the incident </li></ul><ul><li>No patient care </li></ul><ul><ul><li>Don’t get tunnel vision </li></ul></ul>
    32. 33. Response Measures <ul><li>You will feel like there are 100 things to do </li></ul><ul><ul><li>Actually there are closer to 1,000 </li></ul></ul><ul><li>Prioritize the top 10 and complete them first </li></ul><ul><ul><li>Keep a list and check off what has been done </li></ul></ul><ul><ul><li>Constantly reassess priorities </li></ul></ul><ul><li>Keep a timeline of events, document everything </li></ul><ul><li>Manage by objectives </li></ul>
    33. 34. Response Measures <ul><li>Utilize the HICS Command Box in the boardroom </li></ul><ul><ul><li>Preprinted forms, check sheets, clipboards, etc </li></ul></ul><ul><li>Wear the Incident Commander Vest </li></ul><ul><ul><li>Other agencies (Fire/Police) will need to be able to identify you at a glance </li></ul></ul><ul><li>If needed, Use two-way radios to communicate with staff </li></ul><ul><ul><li>Keep communications short and to the point </li></ul></ul><ul><ul><li>No use of 10 codes </li></ul></ul>
    34. 35. Response Measures <ul><li>Think ahead by asking yourself “What if” </li></ul><ul><ul><li>What if another incident happens </li></ul></ul><ul><li>Make decisions with authority </li></ul><ul><ul><li>Resist the temptation to let everyone “do their own thing” or “they know what to do” </li></ul></ul><ul><li>Improvise </li></ul><ul><li>Use common sense </li></ul><ul><li>Keep patients & staff safe </li></ul><ul><li>Document, Document, Document </li></ul><ul><ul><li>You cannot over document an incident </li></ul></ul>
    35. 36. Response Measures <ul><li>Use HICS-ICS forms to document event </li></ul><ul><ul><li>202 Incident Objectives </li></ul></ul><ul><ul><li>203 Organizational Assignments </li></ul></ul><ul><ul><li>206 Staff Medical Plan </li></ul></ul><ul><ul><li>209 Incident Status Summary </li></ul></ul><ul><ul><li>213 General Message </li></ul></ul><ul><ul><li>215a Incident Action Plan Safety Analysis </li></ul></ul><ul><ul><li>251 Facility System Status Report </li></ul></ul><ul><ul><li>254 Disaster Victim Patient Tracking </li></ul></ul><ul><ul><li>260 Patient Evacuation Tracking </li></ul></ul>
    36. 37. Transfer of Command <ul><li>Moves the responsibility for incident command from one Incident Commander to another </li></ul><ul><li>Must include a transfer of command briefing </li></ul><ul><ul><li>Oral </li></ul></ul><ul><ul><li>Written </li></ul></ul><ul><ul><li>Both oral and written </li></ul></ul>
    37. 38. FEMA On-Line Training <ul><li>http://training.fema.gov/IS/crslist.asp </li></ul>
    38. 39. Scenario <ul><li>At 3:00am a sprinkler head is accidentally knocked off by housekeeping in room 125 Soiled Utility </li></ul><ul><li>Objectives </li></ul><ul><ul><li>Stop the flow of water </li></ul></ul><ul><ul><li>Protect patients, staff, facility </li></ul></ul><ul><ul><li>Ensure safe patient care and medical management </li></ul></ul><ul><ul><li>Evacuate the facility (partial or complete) if needed </li></ul></ul>
    39. 40. Scenario <ul><li>At 8:00pm a small fire is discovered in a trash can in UCC waiting </li></ul><ul><li>Objectives </li></ul><ul><ul><li>Implement RACE </li></ul></ul><ul><ul><li>Rescue and protect patients and staff </li></ul></ul><ul><ul><li>Implement partial evacuation </li></ul></ul><ul><ul><li>Communicate situation with staff and patients </li></ul></ul>
    40. 41. Scenario <ul><li>10:00pm on a Friday night, a school bus full of high school band members (32) is rear-ended by a gravel truck at the intersection of Precinct Line and Mid Cities </li></ul><ul><li>28 of the band members present at the ER door. All have lacerations/bruising, some have broken arms/fingers. </li></ul><ul><li>EMS and Fire are on-scene and the Fire Captain comes to the ER </li></ul>
    41. 42. Unified Command <ul><li>The hospital incident commander and Fire department incident commander work together to create and Incident Action Plan </li></ul><ul><ul><li>EMS/UCC staff triage patients </li></ul></ul><ul><ul><li>Care for those that we have the resources and staff </li></ul></ul><ul><ul><li>Stabilize those who need a higher level of care </li></ul></ul><ul><ul><li>EMS Transport to a higher level of care </li></ul></ul><ul><ul><li>Notify school and parents </li></ul></ul><ul><ul><li>Prepare for an influx of parents and media </li></ul></ul>
    42. 43. Did We Meet Our Objectives? <ul><li>Develop a basic understanding of the Incident Command System </li></ul><ul><li>Be able to write an Incident Action Plan </li></ul><ul><li>Be able to describe the Incident Notification Process </li></ul><ul><li>Be able to distinguish between internal and external Situation Analysis and Monitoring </li></ul><ul><li>Establish Immediate Response Measures </li></ul>
    43. 44. Questions?