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

National Incident Management System (NIMS)

National Response Framework (NRF)

Hospital Incident Command System (HICS)

IS 100.HC, 200.a, 700.a, 800.b

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.

NIMS National Incident Management System

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

• A comprehensive, national approach to incident management that is applicable to all jurisdictional levels and across functional disciplines.

(700-2-4)

• The intent is to be applicable across a full spectrum of potential incidents and hazard scenarios, regardless of size or complexity. (700-2-3)

• Designed to improve coordination and cooperation between public and private entities in domestic management activities.

• Response actions will be based on the ICS system.

• All First Responders comply with NIMS training requirements.

NIMS National Incident Management System

Established to create uniformity:

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

NIMS Implementation Activities for Hospitals

• Similar to expectations placed on government agencies

• Consists of 14 objectives for FY 2009• We will cover all requirements in detail in the

next section: “Update on NIMS Requirements”.

NIMS Compliance

• HSPD-5 issued in 2004• For disaster response agencies and departments,

NIMS made a condition for Federal assistance• Confusion over initial NIMS compliance for

hospitals and healthcare facilities• Initial compliance date Oct 1, 2006 pushed back

to Oct 1, 2007.• Annual FY requirements and 5-year plan

(700-2-7)

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

Coordination

(700-3-5)

NIMS Aligns command, control,

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

Used for all events

Knowledge

Abilities

Resources

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

(700-3-5)

NRF Applicability

The NRF applies to all Federal departments and agencies that have primary jurisdiction for or participate in operations requiring a Federal response, including:

Major disasters, emergencies, and terrorist incidents including threats

Other events of lesser severity requiring a coordinated Federal response

Incidents of National Significance

The NRF distinguishes between:

– Incidents that require the Secretary of Homeland Security to manage the Federal response, termed Incidents of National Significance, and,

– The majority of incidents occurring each year that are handled by responsible jurisdictions or agencies

DHS Secretary must declare an event as an Incident of National Significance

DHS Secretary must declare an event as an Incident of National Significance

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

Describe the structures and responsibilities for coordinating incident resource support

Provide guidance for the functional processes and administrative requirements

Address contingency or hazard situations requiring specialized application of the NRF

Emergency Support Function Annexes - 15

Emergency Support Function Annexes - 15

Scope of Emergency Support Functions

ESF #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 wildland, rural, and urban firefighting operations

•Coordination of Federal firefighting activities •Support to wildland, 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 Services


ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services


ESF #7 – Logistics Management and Resource Support


ESF #7 – Logistics Management and Resource Support


ESF #8 – Public Health and Medical Services

Dept Health & Human Srvcs.

ESF #8 – Public Health and Medical Services

Dept Health & Human Srvcs.

•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


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


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


ICS

Incident Command System

HICS is:• A Proven Emergency Management System Based on Military

and Fire Management Chains of Command

• Designed for all hazards and all sizes of response, as necessary

• Flexible and adaptable – only activate what is needed.

• Manages routine or planned events

• Provides logistical & administrative support to operational personnel

• Improves Communication – Formal and Informal

• Cost effective – avoids duplication of effort

• Allows for adaptation into a common response structure (100-2-16; 200-2-9; 200-6-5/7)

Characteristics of ICS

• Common Terminology (100-3-6/9)

• Modular organization• Reliance on an Incident Action Plan (IAP)• Management by objectives• Chain of command and Unity of command (200-2-6)

• Unified Command (700-6-17)

• Manageable Span of Control (100-3-19/21; 200-3-4)

• Emergency Operations Centers• Resource Management• Information, Intelligence and Communications

ICS Terminology

SectionsDivisionsGroupsBranchesTask ForcesStrike TeamsResources

Sections

• Organizational levels with responsibility for a major functional area of the incident

• Operations• Planning• Logistics• Finance/Administration

• The person in charge is the Chief

Divisions and GroupsDivisions

– Divide an incident geographically – Is led by a Supervisor

Groups– Established based on the needs of an

incident. – Labeled according to the job that they are

assigned– Managed by a Supervisor– Work wherever their assigned task is

needed and are not limited geographically

Branches and UnitsBranches

– Established if the number of Divisions or Groups exceeds the span of control

– Have functional or geographical responsibility for major parts of incident operations

– Managed by a Branch Director

(200-4-24)

Units– Organizational elements that have

functional responsibility for a specific activity

Task Forces

• Task Forces are a combination of mixed resources with common communications

• Operate under the direct supervision of a Task Force Leader

Strike Teams

Strike Teams are a set number of resources– Of the same kind and type– With common communications – Operate under the direct supervision of a

Strike Team Leader

Resources• Single: An individual(s) or piece of equipment with its personnel

complement; or,

• A crew or team of individuals with an identified supervisor

• Staging Areas hold resources waiting for operational assignment. (100-3-26; 200-4-19)

• Typing: Identifies size, capability and staffing qualifications. (200-6-14)

• Assigned, Available or Out-of-Service (100-4-4)

ICS Supervisory TitlesOrganizational

Level

Title Support Position

Incident Command Commander

Deputy(* Able to assume command!)

Command Staff Officer Assistant

General Staff (Section)

Chief Deputy

Branch Director Deputy

Division/Group Supervisor N/A

Unit Leader Manager

Strike Team/Task Force

Leader Single Resource Boss

Other Command Issues& Terms

Initiation of Command

Transfer of Command

Termination of CommandDemobilization (700-5-15, pg 121) - Facilitates accountability

Credentialing (700-5-23, pg 129) - Competence and proficiency

Area Command, On-Scene Command

(700-6-20, pg 155) - multiple incidents handled by separate IC orgs.

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

• Need to understand “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. (200-7-5)

• Delegation of authority can occur if the scope of the response is complex or beyond capabilities or authority.

(200-3-8)

• All with a need to know should be told the effective time and date of the transfer. (200-7-6)

Specific Command IssuesTermination 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 “Activation” section

• Need to understand demobilization and what is involved


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 (700-5-15)


Credentialing: Evaluation and 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

(700-5-23)


Area Command: Creates to oversee the management of:

• Multiple incidents that are each being handled by an Incident Command System organization

• A very large incident that has multiple Incident Management Teams assigned to it

• Designed to ensure the effective management of assigned incidents

(700-6-20)

Incident Occurs

Tactical Response

ICS LaunchedIncident Reported

& Identified

Management by Objectives

Chiefs Meeting:Develop Strategy& Tactics to Meet

ObjectivesIncident

Action Plan

IC Sets Objectives

Tactical ResponseInitiatedOperation Reports

Tactical Results, Needs,Engage Liaison,

Logistics, Planning,Finance for support

Planning EvaluatesProgress Reports

Chiefs & OfficersSet Meeting withIC to Re-evaluate

(100-3-15/18)(700-6-11)

(200-5-7)

ICS Form 201 – Incident Briefing Form

•An eight-part form that provides an Incident Command/Unified Command with basic information that can be used to brief incoming resources, an incoming Incident Commander or team, or an immediate supervisor.

•The basic information includes the:

•Incident situation (map and significant events).•Incident objectives.•Summary of current actions.

•Status of resources assigned to or ordered for the incident or event.

•Can serve as the initial Incident Action Plan (IAP) for the first shift change and will remain in force and continue to develop until the response ends, or until a Planning Section has been established and generates, at the direction of the Incident Commander, an IAP.

•Suitable for briefing assigned and newly arriving Command and General Staff members.• (200-4-38)

ICS Form 201

Page 1 of 8 pagesSee handouts

Incident Command SystemOrganizational Charts

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

Creates confusion over position titles and duties. (100-5-3)

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

and understood during an event.

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

(100-5-17; 200-6-6; 700-6-15)

(100-5-17)

HOSPITAL INCIDENT COMMAND SYSTEM

HICS (2003)

HOSPITAL INCIDENT COMMAND SYSTEM

HICS (2006)

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



ICS – Command Section

Liaison Officer





Command Staff

General Staff

• Manages all emergency activities, including development, implementation, and review of strategic decisions from the Command Post, as well as post event assessment during recovery. Top priority = Safety! (100-3-26; 200-2-15; 700-6-5; 700-6-11)

• Serves as the authority for all emergency response efforts and supervisor to the Public Information Officer (PIO), Liaison Officer, Safety Officer, Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance & Administration Section Chief.

• 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. (100-5-7)

• The only position ALWAYS staffed in an ICS activation. (100-5-6)

Incident Commander

• Responsible for relaying incident related information to the public, other organizations and the media. (100-5-18; 700-6-30)

• 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.

• Be 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.

(100-5-18)


• Is responsible for coordinating with external partners, such as the city, 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(100-5-18; 200-4-11/12)

Liaison Officer

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

• Brought about by recent issues in hospitals in New Orleans post Katrina.

Legal Officer

Incident Commander




Liaison Officer





Command Staff

General Staff

Logistics Section

“Boy, do I need stuff”

Logistics Chief• Organize and direct operations associated with

the maintenance of the physical environment:

– Food

– Shelter

– Supplies

– Comms Equipment

– Transportation

– Medical support (100-6-34; 200-4-32)

Logistics Chief

Facility Unit Leader

Communications Unit Leader

Transport Unit Leader

Materials Supply Unit Leader

Nutritional Supply Unit Leader

Incident Commander




Liaison Officer





Command Staff

General Staff

Planning

Planning Chief

• Organize and direct all aspects of the planning section - Incident Action Plan

• Usually runs the Operational Period briefing (Team Chief strategy meeting)

• Document and distribute the facility action plan.

• Ensure distribution of critical information/data.

• Compile scenario projections from all section chiefs and effect long range planning.

• Ensure adequate personnel for response.(100-6-23/24;

200-5-8)

Planning Chief

Labor Pool Unit Leader

Medical Staff Unit Leader

Patient Tracking Officer

Patient Information Officer

Situation Status Unit Leader

Incident Commander




Liaison Officer





Command Staff

General Staff

Finance Section

$$ $$

MONEY MONEY

MONEY MONEY

Finance Section

• Monitor the utilization of financial assets.• Oversee the acquisition of supplies and services

to carry out the medical mission.• Supervise the documentation of expenditures

relevant to the emergency incident.• Pre-planning for a rainy day• Business RECOVERY

(100-4-46/47; 200-4-35)

Finance Chief

Time Unit Leader

Procurement Unit Leader

Claims Unit Leader

Cost Unit Leader

Incident Commander




Liaison Officer





Command Staff

General Staff

Operations Section

• Day to Day activities – On Steroids!• Provision of Care – “Your Hospital’s Mission”• Known as the Tactical Response: Operations, Objectives and

Direction.(100-6-4/5)

(200-4-17) (700-6-11)

Operations Chief

Medical Staff Director

Medical Care Director

Ancillary Services Director

Human Services Director

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

Operations Chief

Human Services Director

Staff SupportUnit Leader

Psychological SupportUnit Leader

Dependent Care Unit Leader

Operations Chief

Ancillary Services Director

Laboratory Unit Leader

Radiology Unit Leader

Pharmacy Unit Leader

Cardiopulmonary Unit Leader

Job Action Sheets

• Each role’s assignments

• Checklists

• Prioritizes duties

• No duplication of duties

• Responsibilities outlined

• Important that staff know to read their Job Action Sheet at the START!!!

Public Health ICS System

(PHICS)

Incident Commander


Safety and Security Officer

Liaison Officer -Internal

Logistics Chief Planning Chief Finance Chief Operations Chief

PHICS

Liaison Officer - External

Legal Officer

Safety and Security OfficerPublic Information Officer

Incident Commander

ADPH Incident Command System Positions Chart January 4, 2010

Incident ManagementAdvisory Group/

CEP

Materials Supply & Nutrition Unit

Leader

Transportation Unit Leader

Damage Assessment Unit

Leader

Communications Unit Leader

Planning Chief

Situation Status Unit Leader

Human Resources Unit Leader

Strategic Epidemiology & Surveillance Unit

Leader

Finance Chief

Time Unit Leader

Procurement Unit Leader

Logistics Chief Operations Chief

Liaison Officer ExternalLegal OfficerLiaison Officer Internal

Operations Section continued on next

page

Safety and Security OfficerPublic Information Officer

Legal Officer

Incident Commander Incident ManagementAdvisory Group/

CEP

Liaison Officer Internal Liaison Officer External

Food Safety Group

Patient Management Group

EMS Group

Patient Placement Unit

Medical Needs Shelter

Pharmaceutical SupportPharmacySocial Service

Coordination Branch

LaboratoryBranch

EnvironmentalGroup

Medical Care Branch

Field SurveillanceBranch

Subject Matter Experts Biological Chemical Radiation Zoonotic Infection Control

Operations Chief

Pharmaceutical SupportVaccination

LaboratoryBranch

ADPH Incident Command System Positions Chart - Operations

January 4, 2010

TRAINING

http://training.fema.gov/IS/crslist.asp

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