National Incident Management System (NIMS) National Response Framework (NRF) Incident Command System...

National Incident Management System (NIMS)

National Response Framework (NRF)

Incident Command System (ICS)

Independent Study – FEMA Courses

The University of South AlabamaCenter for Strategic Health Innovation

© University of South Alabama Center For Strategic Health Innovation. All Rights Reserved.These slides are a part of the ARRTC program and cannot be reproduced for commercial purposes.

August 7, 2012

NIMS - National Incident Management System

• A standardized, all-hazard incident and resource management concept

• A national approach to incident management that is applicable to all jurisdictional levels

• Applicable across a full spectrum of incidents and scenarios, regardless of size

• Improve coordination and cooperation between public and private entities

• Response actions will be based on the ICS system

• All Response Agencies must comply with NIMS

NIMS:

NIMS Implementation Objectives:– Preparedness - Planning, Training and Exercises– Communication and Information Management– Command and Management– NIMS Adoption

Established to create uniformity:

– Organization Structure (ICS)– Plans– Training/Exercises– Resources– Communications/Technology

OrganizationOrganization

NIMS - National Incident Management System

NIMS Implementation RequirementsActivities for Health Care Agencies

July 1, 2012

Consists of 11 Elements

NIMS Compliance• HSPD-5 (Management of Domestic Incidents) issued in 2004

• For disaster response agencies and departments, NIMS is a condition for Federal Preparedness assistance

• NIMS Implementation for Healthcare Organizations Guidance

• Revised activities from 14 to 11

• DHHS requires that healthcare organizations implement NIMS in order to eligible for preparedness funding through ASPR/HPP program.

Adoption:Element 1 - Adoption of NIMS…throughout the healthcare organization

including all appropriate departments and business units.

• NIMS objectives addressed in the facility’s Emergency Management Program (EMP/Emergency Operations Plan – EOP) documentation.

• Include a statement of adoption of NIMS in the EOP

• Refer to this tool and attach as an annex or sub-section of the EOP

• Obtain leadership support and have them review/sign plans

• Assign a NIMS Compliance Officer

Organizational Implementation Requirements

Adoption:Element 2 – Federal Preparedness awards support NIMS Implementation…

in accordance with the eligibility and allowable use of the awards.

• Utilize the Hospital Preparedness Program (HPP) funding for NIMS training courses.

• Document that HPP funds purchase standardized equipment in the county/state/ country.

• The EMP documentation includes the use of ICS and associated activities.


Preparedness: PlanningElement 3 – Revise and Update EOPs, SOPs and SOGs to incorporate

NIMS components.

• Revise plans as necessary to incorporate:

•Planning•Training•Response•Exercises

•Equipment•Evaluation•Corrective Action


Preparedness: PlanningElement 4 - Mutual-Aid and/or Assistant Agreements…to include

public/private sector and non-governmental organizations.

• The EMP references Memorandums of Understanding (MOUs), agreements and/or mutual aid developed with hospitals, other healthcare providers, local public health, Emergency Medical Services (EMS), fire and safety, pharmacies, medical suppliers, water/food/fuel suppliers, etc.


Preparedness: Training and ExercisesElement 5 – IS 100, 200 and 700.

•Security/Safety•Laboratory•Radiology•Inter-facility

Transport

•Maintain a record of completion and copies of completion certificates

• Physicians• Nurses• Ancillary• Materials/Resource Managers

Personnel to fill ICS Positions who must have documented training:


Preparedness: Training and ExercisesElement 6 – IS 800

• Those who take the lead in key ICS positions• Key staff members – Liaison, Safety/Security, Legal…• Incident Commander• Emergency Management Planner• Maintain a record of completion.• Copies of completion certificates should also be maintained.


Preparedness: Training and ExercisesElement 7 – Apply NIMS/ICS to training and exercises • Utilize HICS for disaster exercises and actual events• The EMP training and exercise documentation reflects the use of NIMS and HICS• Utilize Homeland Security Exercise and Evaluation (HSEEP)• Work in partnership with local/regional healthcare providers within the community to organize training and

exercises that use NIMS and HICS• Hospital should develop goals and objectives to follow during a drill that tests their ability to activate HICS, open

their Command Post, develop and implement an Incident Action Plan (IAP), and communicate with partners

• Develop/use After Action Reports and Corrective Action Plans


Communication and Information Management:Element 8 – Processes, Equipment, Communication and Data interoperability• Facilitate collection and distribution of consistent & accurate information

• Situational awareness of logistical resources

• Equipment purchased through the HPP is standardized

• The EMP documentation includes emphasis on the interoperability of response equipment and communications and data systems with external agencies

• Systems such as AIMS, ALERT, Web-EOC, etc. show compliance if utilized among healthcare facilities, county/area or state-wide.


Communication and Information Management:Element 9 – Common and consistent terminology

• The EMP includes emphasis on the use of plain English by staff during emergencies. Review and update EOP annually.

• Document a statement to this effect in the EMP documentation or EOP.• Utilize a HICS acronym list.


Command and Management:Element 10 – Manage events with ICS

• The EOP explains the use of HICS, particularly incident action planning, a common communications plan and five specific activities: Initiation of Command, Transfer of Command, Termination of Command, Demobilization and Credentialing.

• Documentation utilization of HICS or other approved ICS structures as detailed in #7.


Command Issues & Terms

• Initiation of Command

• Transfer of Command

• Termination of Command• Demobilization - Facilitates accountability

• Credentialing - Competence and proficiency

Specific Command Issues

Initiation of Command:

• IC or Temporary IC need to know what they do

• Must be able to recognize the need to activate HICS

• Need a list of criteria to make the decision

• Have a group or select staff to ask for advice

• Update EOP with “Activation” section

• Understand how to transition into “Transfer of Command”


Transfer of Command:

• Follow EOP guidelines after “Initiation of Command”

• Upon arrival, the higher ranking individual will assume command, maintain command or reassign to a third party.

• Delegation of authority can occur if the scope of the response is complex or beyond capabilities or current/initial Incident Commander

• All with a need to know should be told the effective time and date of the transfer.


Termination of Command:

• IC needs to know what they do

• Must be able to recognize the time to de-activate HICS

• Need a list of criteria to make the decision

• Have a group or select staff to ask for advice

• Update EOP with “De-Activation” section

• Understand the transition into demobilization


Demobilization: The process of standing down

•Getting back to a normal schedule and routine

•Replacing equipment and supplies

•Adjusting personnel back to routine

•Planning begins at the same time as mobilization

•Facilitates accountability and efficiency

•Occurs in the Planning Section


Credentialing: Evaluation/documentation of an individual's:

• Current certification, license, or degree• Training and experience• Competence or proficiency • Critical for health care agencies• National, state, local AND agency requirements• Legal implications

Command and Management:Element 11 – Adopt Public Information (PI) principles by using both JIS and

JIC during events (Examples)

• The EOP explains the management and coordination of public information with external entities

• Indentify a PIO who is responsible for medial and public information as it pertains to an event. The PIO should establish working relationships, prior to an event with local media, EMA, law enforcement, public health, EMS, and other responding agencies

• PIO understands the relationship with the Joint Information System and Joint Information Center

• Documentation that the hospital participates in the JI process locally


Questions and/or a copy of the NIMS compliance manual:

[email protected]

[email protected]

251-461-1805

mailto:[email protected]

mailto:[email protected]

National Response FrameworkNational Response Framework

Went into effect in March 2008.

Updated and revised the National Response Plan.

The NRF establishes . . .• Federal coordination structures/mechanisms• Direction for incorporation of existing plans• Consistent approach to managing incidents

CoordinationCoordination

NIMS Aligns command, control,

organization structure, terminology, communication protocols, & resources/resource-typing

Used for all events

StateResponse or Support

FederalResponse or Support

Incident

NRF Integrates & applies Federal

resources, knowledge, & abilities before, during, & after an incident

Implemented for incidents requiring Federal coordination

LocalResponse

Relationship: NIMS vs. NRF

NRF Structure

Support AnnexesSupport Annexes

Incident AnnexesIncident Annexes

AppendixesAppendixes

Base FrameworkBase Framework Describes the domestic incident management structures and processes

Include acronyms, definitions, authorities, and a compendium of national interagency plans

Provide guidance for the functional processes and administrative requirements

Address contingency or hazard situations requiring specialized application of the NRF

Describes the structures and responsibilities for coordinating incident resource support

Emergency Support Function Annexes - 15

Emergency Support Function Annexes - 15

Scopes of ESFsESF #1 – Transportation

Department of Transportation

ESF #1 – Transportation

Department of Transportation

•Aviation/airspace management and control •Transportation safety •Restoration/recovery of transportation infrastructure •Movement restrictions •Damage and impact assessment

•Aviation/airspace management and control •Transportation safety •Restoration/recovery of transportation infrastructure •Movement restrictions •Damage and impact assessment

ESF #2 – Communications

Homeland Security/NCS

ESF #2 – Communications

Homeland Security/NCS

ESF #3 – Public Works and Engineering

Department of DefenseUS Army Corps of Engineers

ESF #3 – Public Works and Engineering

Department of DefenseUS Army Corps of Engineers

ESF #4 – Firefighting

Department of Agriculture

ESF #4 – Firefighting


•Coordination with telecommunications and information technology industries •Restoration and repair of telecommunications infrastructure •Protection, restoration, and sustainment of national cyber and information technology resources •Oversight of communications within the Federal incident management and response structures

•Coordination with telecommunications and information technology industries •Restoration and repair of telecommunications infrastructure •Protection, restoration, and sustainment of national cyber and information technology resources •Oversight of communications within the Federal incident management and response structures

•Coordination of Federal firefighting activities •Support to wild land, rural, and urban firefighting operations •Coordination of Federal firefighting activities •Support to wild land, rural, and urban firefighting operations

•Infrastructure protection and emergency repair •Infrastructure restoration •Engineering services and construction management •Emergency contracting support for life-saving and life-sustaining services

•Infrastructure protection and emergency repair •Infrastructure restoration •Engineering services and construction management •Emergency contracting support for life-saving and life-sustaining services

ESF #5 – Emergency Management

Homeland Security/FEMA

ESF #5 – Emergency Management


ESF #6 – Mass Care, Emergency Assistance,

Housing, and Human ServicesHomeland Security/FEMA

ESF #6 – Mass Care, Emergency Assistance,

Housing, and Human ServicesHomeland Security/FEMA

ESF #7 – Logistics Management and Resource Support


ESF #7 – Logistics Management and Resource Support


ESF #8 – Public Health and Medical Services

Dept Health & Human Services

ESF #8 – Public Health and Medical Services

Dept Health & Human Services

•Coordination of incident management and response efforts •Issuance of mission assignments •Resource and human capital •Incident action planning •Financial management

•Coordination of incident management and response efforts •Issuance of mission assignments •Resource and human capital •Incident action planning •Financial management

•Mass care•Emergency assistance •Disaster housing •Human services

•Mass care•Emergency assistance •Disaster housing •Human services

•Comprehensive, national incident logistics planning, management, and sustainment capability •Resource support (facility space, office equipment and supplies, contracting services, etc.)

•Comprehensive, national incident logistics planning, management, and sustainment capability •Resource support (facility space, office equipment and supplies, contracting services, etc.)

•Public health •Medical •Mental health services •Mass fatality management

•Public health •Medical •Mental health services •Mass fatality management

Scopes of ESFs

NRF – ESF 8 at the Federal Level

Alabama EOP – ESF 8 at the State Level

Tier 6 -----------

Tier 5 ----------

Tier 4 ----------

Tier 3---

Tier 2 ---

Tier 1----

Federal Response

Inter-state Coordination

Intra-state Coordination

Area Jurisdiction Response: Area Health Care Coalition

County Jurisdiction Response:County Health Care Coalition

Health Care Facility Response

DHHS

Region 4 DHHS

ADPH/CEP

Area PH

County PH

HCF

ESF #9 – Search and Rescue


ESF #9 – Search and Rescue


•Life-saving assistance •Search and rescue operations •Life-saving assistance •Search and rescue operations

ESF #10 – Oil and Hazardous Materials Response

EPA

ESF #10 – Oil and Hazardous Materials Response

EPA

ESF #11 – Agriculture and Natural Resources


ESF #11 – Agriculture and Natural Resources


ESF #12 – Energy

Department of Energy

ESF #12 – Energy

Department of Energy

•Oil and hazardous materials (chemical, biological, radiological, etc.) response •Environmental short- and long-term cleanup

•Oil and hazardous materials (chemical, biological, radiological, etc.) response •Environmental short- and long-term cleanup

•Nutrition assistance •Animal and plant disease and pest response •Food safety and security •Natural and cultural resources and historic properties protection and restoration •Safety and well-being of household pets

•Nutrition assistance •Animal and plant disease and pest response •Food safety and security •Natural and cultural resources and historic properties protection and restoration •Safety and well-being of household pets

•Energy infrastructure assessment, repair, and restoration •Energy industry utilities coordination •Energy forecast

•Energy infrastructure assessment, repair, and restoration •Energy industry utilities coordination •Energy forecast

Scopes of ESFs

ESF #13 – Public Safety and Security Department of Justice

ESF #13 – Public Safety and Security Department of Justice

ESF #14 – Long-Term Community Recovery


ESF #14 – Long-Term Community Recovery


ESF #15 – External Affairs


ESF #15 – External Affairs


•Facility and resource security •Security planning and technical resource assistance •Public safety and security support •Support to access, traffic, and crowd control

•Facility and resource security •Security planning and technical resource assistance •Public safety and security support •Support to access, traffic, and crowd control

•Social and economic community impact assessment •Long-term community recovery assistance to States, local governments, and the private sector •Analysis and review of mitigation program implementation

•Social and economic community impact assessment •Long-term community recovery assistance to States, local governments, and the private sector •Analysis and review of mitigation program implementation

•Emergency public information and protective action guidance •Media and community relations •Congressional and international affairs •Tribal and insular affairs

•Emergency public information and protective action guidance •Media and community relations •Congressional and international affairs •Tribal and insular affairs

Scopes of ESFs

ICS

Incident Command System

Incident Commander

Public Information Officer

Logistics Section Chief

Incident Command System (ICS) Model

Liaison Officer

Safety & Security Officer

Planning Section Chief

Finance/Admin Section Chief

Operations Section Chief

Command Staff

General Staff

Incident Command System Organizational Charts

Theoretically, your ICS chart should not correlate with any administrative organizational chart in you facility:

Creates confusion over position titles and duties.

In reality, for hospitals, a HICS chart that matches (or comes close to matching) your day-to-day organizational chart is much more effective and understood during an event.

HOSPITAL INCIDENT COMMAND SYSTEM

HICS (2003)

HOSPITAL INCIDENT COMMAND SYSTEM

HICS (2006)

Management by ObjectivesIncident Occurs

Incident Reported

& Identified

Tactical Response

ICS Launched

IC Sets Objectives

Chiefs Meeting:Develop Strategy& Tactics to Meet

ObjectivesIncident

Action Plan

Tactical ResponseInitiatedOperation Reports

Tactical Results, Needs,Engage Liaison,

Logistics, Planning,Finance for support

Planning EvaluatesProgress Reports

Chiefs & OfficersSet Meeting withIC to Re-evaluate

The Five Sections

• Command = the buck stops here

• Planning = creates & develops incident plan

• Operations = implement the plan

• Logistics = supports the plan.

• Finance = pays for the plan.

Incident Commander



Liaison Officer




Operations Section

Command Staff

Incident Commander



ICS – Command Section

Liaison Officer





Command Staff

General Staff

• Manages all emergency activities, usually from the Command Post.

Top priority = Safety!

• Serves as the authority for the response efforts and is supervisor to the Command and General Staff.

• May serve as any or all of the positions in the Command and General Staff, depending on the complexity of the event.

• Is IC until authority is transferred to another person.

• The only position ALWAYS staffed in an ICS activation.

Incident Commander

• Responsible for relaying incident related information to the public, other organizations and the media.

• Participate in a Joint Information System (JIS) and work in the local Joint Information Center (JIC) when activated.

• Communicates with other agencies’ public information officers.

• The organizer of correct information.

• Manage the facility’s Public Information Plan.


• Monitors, evaluates and recommends procedures for all incident operations for hazards and unsafe conditions.

• Monitors, evaluates and recommends procedures for all incident operations, including the health and safety of emergency responder personnel.

• Organizes and reinforces scene/facility protection and traffic.

• Establish a security command post.


• Is responsible for coordinating with external partners, such as the county, state, federal agencies, and public and private resource groups, as well as other Health Care Facilities.

• Serves as the incident contact person for representatives from other agencies and may work from the local Emergency Operations Center.

• Communicates into and out of the hospital.

• Works closely with the IC and PIO

Liaison Officer

• Provides legal and ethical advice to the IC, Command Staff, General Staff and the agency.

Legal Officer

Incident Commander




Liaison Officer





Command Staff

General Staff

Logistics Section

“Boy, do I need stuff”

Logistics Chief

Facility Unit Leader

Communications Unit Leader

Transport Unit Leader

Materials Supply Unit Leader

Nutritional Supply Unit Leader

2003

Logistics Chief

Service Branch Director•Communications Unit•ITAS Unit•Staff Food and Water Unit

Support Branch DirectorEmployee Health and Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool and Credentialing Unit

2006

Incident Commander




Liaison Officer





Command Staff

General Staff

Planning

Planning Chief

Labor Pool Unit Leader

Medical Staff Unit Leader

Patient Tracking Officer

Patient Information Officer

Situation Status Unit Leader

2003

Planning Chief

Documentation Unit Leader

Demobilization Unit Leader

Situation Unit Leader

2006

Resource Unit Leader•Personnel Tracking•Material Tracking

•Personnel Tracking•Material Tracking

Incident Commander




Liaison Officer





Command Staff

General Staff

Finance Section

$$ $$

MONEY MONEY

MONEY MONEY

Finance Chief

Time Unit Leader

Procurement Unit Leader

Claims Unit Leader

Cost Unit Leader

2003

Finance Chief

Time Unit Leader

Procurement Unit Leader

Compensation/Claims Unit Leader

Cost Unit Leader

2006

Incident Commander




Liaison Officer





Command Staff

General Staff

Operations Chief

Medical Staff Director

Medical Care Director

Ancillary Services Director

Human Services Director

2003

Operations ChiefMedical Staff Director Medical Care Director

In-Patient Areas Supervisor

Treatment Areas Supervisor

Surgical ServicesUnit Leader

General NursingUnit Leader Out-Patient

Services Leader

Maternal & ChildUnit Leader Critical CareUnit Leader

Delayed TxUnit Leader

Immediate TxUnit Leader

TriageUnit Leader

Minor TxUnit Leader

MorgueUnit Leader

Discharge Unit Leader

2003

Operations Chief

Human Services Director

Staff SupportUnit Leader

Psychological SupportUnit Leader

Dependent Care Unit Leader

2003

Operations Chief

Ancillary Services Director

Laboratory Unit Leader

Radiology Unit Leader

Pharmacy Unit Leader

Cardiopulmonary Unit Leader

2003

Operations Chief

Staging Manager

Medical Care Branch Director

2006

Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging Team

Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit

Operations ChiefInfrastructure Branch Director

Haz-Mat Branch Director

2006

Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit

Detection/Monitoring UnitSpill Response UnitVictim Decontamination UnitEquipment Decontamination Unit

Operations Chief

Security Branch Director

Business Continuity Branch Director

2006

Personnel Staging TeamVehicle Staging TeamEquipment/Supply Staging TeamMedication Staging Team

Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement / Interface Unit

FEMA TRAINING

NIMS Elements 5 & 6

IS 100

IS 200

IS 700

IS 800

training.fema.gov/is/

Required Courses

Questions

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