Unified Command Unity of Command Unified Command o Used when more than one agency has incident jurisdiction or when incidents cross political jurisdictions o Provides guidelines to enable agencies with different legal, geographic, and functional responsibilities to coordinate, plan, and interact effectively o Agencies maintain their own authority, responsibility, and accountability o A single, coordinated Incident Action Plan is developed and implemented Unity of Command o Each individual involved in the response operates under only one designated supervisor o Prevents divided loyalties and allows greater span of control o Clarifies reporting relationships and limits risks from confused lines of authority

1. Healthcare Facilities Incident
Command
(Principles)
Tehran University of Medical Sciences
School of Public Health
Department of Disaster Public Health
Ministry of Health & Medical Education
National Institute of Health Research
Department of Disaster & Emergency Health
Shahid Sadoughi University of Medical Sciences
Allied Medical School
PreHospital Emergency Care Department

2. Introduction
D u r i n g a D i s a s t e r
Preparedness and Organization of a healthcare facility
Required to
Maximize the utilization of the available resources
To Provide
The highest achievable level of care for the community

3. The highest achievable level of care for the
community require to:
Development of an Emergency Management Program (EMP) aimed
at:
1) Protecting the facility and its people (patients and staff)
2) Responding to the community’s increased healthcare needs
3) Continuing to provide healthcare services
4) Assuring the safety of all involved

4. HealthCare's Facility Management
(Normal Condition Vs. Disaster)
Normal Condition:
Functioning and managing healthcare
utilizing consensus decision-making
based on extensive data
Disaster:
Requires that time-sensitive decisions be
made with imperfect information

5. Command Structure
Controlling the situation not only requires planning, it requires the
delineation of alternate roles and responsibilities of hospital staff in
an organized management system
Central to this organization is a command structure that details the
roles and responsibilities of those involved in leading the healthcare
facility through all phases of a disaster

6. Focus of ICS
Incident management focuses on 
Command
Control
Coordination
 Through a responsibility-oriented chain of command

7. Roles and responsibilities in ICS
To ensure understanding of the Scope of The Assignment 
To ensure understanding of the Chain of Command 
Roles and responsibilities in ICS Should 
 Clearly defined
 Rehearsed in drills
These roles should be created from the hospital’s Emergency Operations
Plan (EOP), which details
 Who is in charge
 Which implementation strategy for the appropriate ICS should be
installed

8. THE INCIDENT COMMAND SYSTEM
Definition:
ICS is an “all-hazard” approach to incident management that is driven
by responsibility/position rather than by person
ICS is a flexible organizational structure capable of shrinking and
expanding based on the size and complexity of the event

9. History of ICS
The foundation for the current ICS was developed in the 1970s by an
interagency task force of local, state, and federal personnel
Initially, the system was designed to coordinate fire personnel
combating large-scale responses, and was developed to correct the
myriad of response-related problems that repeatedly were found by
the task force analyses of prior major incidents

10. These problems included:
o Inadequate communication
o Lack of a standardized management structure
o Lack of personnel accountability
o Lack of a systematic planning process

11. ICS design is meant to:
o Manage all routine, planned events or emergencies, of any size or type, by
establishing a clear chain of command
o Allow personnel from different agencies or departments to be integrated into a
common structure to effectively address issues and delegate responsibilities
o Provide needed logistical and administrative support to operational personnel
o Ensure key command functions are assigned, and eliminate duplication

12. Please attend!!!
T h e I C S d e s i g n d i f f e r s f r o m 
T h a t u s e d i n t h e d a i l y a d m i n i s t r a t i v e s t r u c t u r e
o f t h e a g e n c y o r h e a l t h c a r e f a c i l i t y
I f t h e u s u a l a d m i n i s t r a t i v e s t r u c t u r e a n d
r e s p o n s e p r a c t i c e s a l l o w a d e q u a t e m a n a g e m e n t
o f t h e p r o b l e m 
T h e n a n e m e r g e n c y r e s p o n s e i s n o t w a r r a n t e d ,
a n d a n I C S i s n o t r e q u i r e d t o b e a c t i v a t e d

13. ICS Positions

14. ICS Positions
 The ICS utilizes standard, functional positions within its organizational
structure
 Not all positions are required for every response
 Only those positions that have functions necessary in the current situation are
activated
 But disaster manager must be a designated person in charge of each function
that becomes operational

15. The use of the standardized position titles in the ICS
structure serves three essential purposes
o Reduces confusion within a hospital, or with outside agencies, or other
healthcare facilities, by providing a common name for all users
o Allows the position to be filled with the most qualified individual rather than
by seniority
o Facilitates requests for qualified personnel, especially personnel from outside
of the hospital

16. The Incident Commander
Person in charge of the mission
The only position that always is activated for an incident
(regardless of its nature)
The Incident Commander
o Defines the mission
o Sets all response objectives
o Devises strategies and priorities
o Maintains overall responsibility for managing the incident
o Ensures its completion

17. The Incident Commander may choose to activate the
following Command Staff positions:
o A P u b l i c I n f o r m a t i o n O f f i c e r
Coordinate information sharing with internal personnel and the media
o A S a f e t y O f f i c e r
Monitor operations from a safety perspective and assure the safety of all assigned personnel
o A L i a i s o n O f f i c e r
Serve as the primary contact for external agencies working with the hospital and to
coordinate assistance requests to the Local Emergency Operations Center (LEOC)
In select situations, the Liaison Officer may be assigned to represent the hospital at the LEOC or at
the field Incident Command Post (ICP)

18. Commander, Command Staff and ???
In addition to the Commander and the Command Staff, there are four Sections that
comprise specific management functions within an ICS; each is under the direction
of an assigned chief who reports to the Incident Commander
These positions consist of the:
o O p e r a t i o n s S e c t i o n C h i e f
o P l a n n i n g S e c t i o n C h i e f
o L o g i s t i c s S e c t i o n C h i e f
o F i n a n c e / A d m i n i s t r a t i o n S e c t i o n C h i e f
Each of these four primary management sections may be subdivided to meet the management
demands of the incident

19. Operations Section Chief
o Responsible for directing all tactical operations (e.g., patient care
and facility operations)
o Required to carry out the IAP by using the defined response
objectives and by directing all needed resources

20. Planning Section Chief
Responsible for collecting and evaluating information for 
o Decision support
o Maintaining resource status information
o Preparing documents (such as the IAP)
o Maintaining documentation for incident reports

21. Logistics Section Chief
Responsible for providing
o Support
o Resources
o Other Services Essential
For meeting the response objectives set by the Incident Commander

22. Finance/Administration Section Chief
Responsible for monitoring all costs related to the incident while
providing 
o Accounting
o Procurement
o Time recording
o Cost analyses
To maximize Financial Recovery & Reduce Liability

23. ICS Components

24. ICS Component
In addition to the Incident Commander, his/her four assistant Command Staff,
and the four major functional sections, the ICS may be further divided into
organizational components with a distinct title given to those in charge
o Divisions
o Groups
o Branches
o Units
o Single Resources

25. Divisions
o Used to divide an incident or facility geographically (e.g., first
floor)
o This command function typically is used among non-hospital
response agencies, such as fire and law enforcement authorities
o Each Division is led by a Supervisor

26. Groups
o Established to divide the incident management structure into
functional areas of operation
o They are composed of resources that have been assembled to
perform a special function (not necessarily within a single geographical division)
o Each Group is led by a Supervisor

27. Branches
o Created when the number of Divisions or Groups exceeds the
recommended span of control (e.g., Medical Care Branch and Service Branch)
o Each Branch is led by a Director

28. Units
o Organizational elements that have functional responsibility for a
specific Planning, Operations, Logistics, or Finance/Administration
activity (e.g., Inpatient Unit, Situation Unit and Supply Unit)
o Each Unit is led by a Unit Leader

29. Single resources
Individual(s) or a piece of equipment with its personnel complement
(e.g., perfusionist) or a crew or team of individuals with an identified
Supervisor

30. a Task Force
a Strike Team

31. a Task Force and a Strike Team
The government, the police department, and the fire department
may use two other organizational levels not routinely used in the
hospital setting
o A Task Force
o A Strike Team

32. A Task Force
A combination of mixed resources (e.g., an ICU staff of nurses,
technicians, and station/unit secretaries) with a common
communication capability that is led by a Taskforce Leader

33. A Strike Team
A set number of similar resources (e.g., burn nurses) with a common
communication capability who operate under the command of a
Strike Team Leader
Either a Strike Team or Task Force may be sent to assist a healthcare facility
that requests personnel with specific expertise during an emergency

34. Span of Control
(1:3–7)
o Individuals in charge can delegate authority to others when necessary,
through a chain of command
o This allows an effective span of control to be maintained to ensure safety and
accountability
o The recommended practice for the delegation of authority is to limit personnel
management to a ratio of one supervisor to three-to-seven (1:3–7) reporting
elements

35. Unified Command Vs.Unity of Command

36. Incident
Commander
Operation Planning Logistic Finance
PIO Safety
Liaison