Incident Management for Healthcare Operations Based upon Emergency Management Institute ICS-200HC.

Incident Management for Healthcare Operations

Based upon Emergency Management Institute ICS-200HC

Minnesota Emergency Readiness Education and Training Program

(MERET)

MERET worked with partners in Minnesota to adapt curriculum to support the Hospital Incident Command System (HICS) training

MERET is a program designed to educate and train Minnesota’s health care workers in emergency preparedness, tailoring efforts to the unique needs of specific communities as they prepare for a health emergency or bioterrorism event. MERET is funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services, and is administered by the University of Minnesota Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN, at the School of Nursing, is the Principal Investigator.

Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum Development Program.

Objectives

Name the four (4) phases of comprehensive incident management.

Recognize how objectives shift from the initial response phase to the extended response phase.

Name the order in which the Hospital Incident Command System (HICS) is usually activated.

Select the forms used by the Command and General Section Chief staff.

Identify the role of the Incident Commander. Select the appropriate span of control for any

leadership position in the HICS. Identify the purpose of the Incident Briefing.

Imagine the role you will play in your facility during this presentation

Scenario

30 minutes ago, a tornado warning was issued for a projected touchdown in this community

It is now 6:08 am, storm related injuries have been coming in from surrounding areas. One injured patient is in the OR

Scattered power outages are being reported in the area

Lights are flickering in the hospital There is a roar and the entire facility shakes

momentarily

How you would respond?□ Too busy - it’s 6:08 am and a shift change will

happen in 60 minutes. Day shift can deal with this.

□ Panic - realize that you don’t know anything about the hospital’s Emergency Operations Plan or where to find it.

□ Reassign the most experienced ICU nurse to open the Command Center.

□ Call the on call administrator for back up and begin an immediate plan of action

Incidents Require you to …..

4 Phases of Comprehensive Incident Management (CEM) Activities for “all hazard” planning

Preparedness

Build response capacity/capability

Example: buy dike plugs

Preparedness RecoveryResponseMitigation (Prevention)

Notification

Mitigation

(including prevention) Prevention

activities that reduce impact of hazard

Example: build dikes to prevent flood

Conduct public health surveillance, testing immunizations and quarantine for biological threats

Response

Gain control of an event

Examples: plug dike when a hole appears,

Emergency shelter, housing, food & water

Search and rescue Evacuation Emergency medical

services

Recovery

Return to pre-disaster state

Examples: Repair/replacement of dike, damaged public facilities (bridges, schools, hospitals)

Debris cleanup & removal

Temporary housing

Examples

NIMS slide adaptation

Incident progression

BOOM!

Reactive PhaseRecognitionNotificationsInitial control and safety actionsEstablish ICP

Primary ToolsSOPsJob Action Sheets

Primary GoalPrevent incident expansionPrevent responder injury

Proactive PhaseSituation assessedObjectives establishedStrategies / tacticsResources requested

Primary ToolsICSIncident Action Planning

Primary GoalManage incident

Slide courtesy of John Hick Hennepin County Medical Center

Getting Organized…

INCIDENT BRIEFING

• Date/time of start of incident

• Type of incident

• Services involved

• Current incident status

• Current resource status

• Current strategy/objectives

• Communications systems being used

• Special problems/issues

NatureNature

SizeSize

LocationLocation Time of DayTime of Day

Day of the WeekDay of the Week

InitiallyInitially

MobilizationChecklist

MobilizationChecklist

What ?Where ?When ?Who’s Involved ?Where Is It Going ?

What ?Where ?When ?Who’s Involved ?Where Is It Going ?

Command Post

IncidentAction

Planning

Slide courtesy of VA Emergency Management Training Curricula

Incident Complexity Analysis

Safety issues Impacts to critical operating systems Potential need to evacuate Potential need to relocate services Impact on essential resources and

suppliers (e.g.: water supply) Event is due to criminal action Impact on organization’s reputation

Photos courtesy of FEMA

Managing by Objectives Incident Action Plan (IAP)

There is only one Incident Action Plan at an incident which identifies WHAT must be done? WHO is responsible? How information will be COMMUNICATED? What if a responder is INJURED?

Overall Priorities • Life Saving• Incident stabilization• Property Preservation

Establish Incident Action Plan objectives, strategies, tactics

IMS Feature:Incident Action Plan (IAP)

Reflects the overall strategy for managing an incident within a prescribed timeframe – the operational period (e.g.: 7am-7pm)

IAP is primary source of objectives for action IAP often includes list of resources and

assignments IAP may initially be verbal, but should become

written soon in the process Monitors response to adjust for next period Documents results

IAP Establishes Objectives, Strategies, and Tactics

State what will be accomplished (agency exec and IC)

Establish the general plan or direction for accomplishing the incident objectives (IC)

Tactics Specify how the strategies will

be executed. (Operations)

Incident Objectives

Strategies

Slide courtesy of FEMA

Operational TimesInitial response phase

Extended response phase

Initial Response Phase

Operational periods set by IC usual breakdown

Immediate 0-2 hours Intermediate 2-12 Extended over 12

hours Initiate planning cycle

Extended Response Phase

Incident requires additional operational period (incident duration>8-12 hour)

Determined by Situation

assessment Incident action

planning Resource

management

Incident Action Planning

Forms to include in the IAPHICS 201: Incident Briefing (may serve

as initial IAP)HICS 202: Incident ObjectivesHICS 203: Organization Assignment ListHICS 204: Branch Assignment ListHICS 205: Incident Communications LogHICS 206: Staff Medical PlanHICS 261: Incident Safety Analysis

HICS 201 Form (Incident Briefing)

1. Incident Name,2. Date of Briefing3. Time of Briefing4. Event History 5. Current Actions 6. Summary7. Current Organization8. Notes (Accomplishments, Issues, Directives)9. Name of the individual who prepared the document10. Facility Name

HICS 202 Form (Incident Objectives)1. Incident name

2. Date prepared

3. Time prepared

4. Operational period ( date & time)

5. General command & control objectives for the incident (including alternatives)

6. Weather/environmental implications during the period (forecast, wind speed/direction, daylight)

7. General safety/staff messages to be given

8. Attachments (ex. medical plan, facility system status)

9. Name of the individual who prepared the document

10. Approval of the Incident Commander

11. Facility name

Job Action Sheets (JAS)1. Title2. Purpose3. To whom they report4. Critical action considerations5. Forms required by

the job6. Broken into operational periods

JAS “prompts” the team member to take needed actions related to their roles and responsibilities

Incident Commander

The Incident Commander performs all major ICS command and staff responsibilities unless delegated and assigned.

SafetyOfficerSafetyOfficer

LiaisonOfficerLiaisonOfficer

Public InformationOfficer


Command Staff

IncidentCommander

IncidentCommander

OperationsSection ChiefOperations

Section ChiefPlanning


Section ChiefLogistics


Section ChiefFinance/AdminSection Chief

Finance/AdminSection Chief

General Staff

IncidentCommander

IncidentCommander


Delegation of Authority

An Incident Commander's scope of authority is derived:

From existing responsibilities or agreements Through a delegation of authority from the

agency administrator or elected official in writing or verbally

Grants authority to carry out specific functions and provides overall objectives / guidance

Allows the Incident Commander to assume command.

Does NOT relieve the granting authority of the ultimate responsibility for the incident.

Delegation of authority comes from the governing board of your agency

Incident Commander

Hospital CEO


Incident Commander Review

Provides overall leadership for incident response

Only position ALWAYS staffed Delegates authority to others May appoint deputy if needed Initial IC holds post until they delegate the

post to another qualified / more qualified person

Approves IAP and all major resource requests

Incident Commander Leadership Responsibilities Ensures safe work practices Takes command Motivates responders Demonstrates initiative by taking action Communicates by providing specific

instructions and asking for feedback Supervises the scene of the action Evaluates the effectiveness of the plan Understands and accepts the need to be

flexible, modify plans

Transfer of Command-Review The process of moving the responsibility

for incident command from one Incident Commander to another

Occurs when More qualified person / team arrives End of operational period / extended incident handoff Always includes transfer of command briefing

• Current situation• Response needs• Available resources

All personnel will be informed of the effective time and date of the transfer of command

The modular/flexible organization structure of the ICS allows standardization of positions and number of positions depending on the extent of the incident

ICS organizational structure should include only the functions and positions needed to achieve the incident objectives

ICS positions may not be combined in order to save on staffing or achieve a higher level of efficiency

ICS recognizes that an Incident Commander is always necessary no matter what other additional positions are assigned

Modular Organization


Activation of Organizational Elements

Organizational elements may be activated without activating the Section Chief.

In this case, the unit reports to the IC directly

Deputy positions can be found for the Incident Commander, Branch and Section Chiefs

SituationUnit

SituationUnit

Incident CommanderIncident Commander

Safety OfficerSafety Officer

Operations Section Operations Section

RescueGroup

RescueGroup

Medical Group Medical Group


Supply and Facilities

Unit Leader

Supply and Facilities

Unit Leader

Things To AvoidDo not combine ICS positions to save on staffing.

Individuals may supervise multiple units, but the positions should remain distinct.

Do not use nonstandard titles or hybrid positions. These titles may be unrecognizable to assisting or cooperating personnel.

SupplyUnit Leader

SupplyUnit Leader

Facilities UnitLeader

Facilities UnitLeader

Bob Bob


Command Staff Review The Incident Commander may need to

designate staff who can provide information, liaison, and safety services for the entire organization





Command Staff

IncidentCommander

IncidentCommanderIncident

CommanderIncident

Commander

Public Information Officer, releases information to internal/external stakeholders Safety Officer, advises the IC regarding incident safety, worker and sites

Liaison Officer, coordinates assisting or contributing agenciesSlide courtesy of FEMA

General Staff-Review General Staff in the ICS organizational

structure are appointed as the incident complexity expands





Command Staff

IncidentCommander

IncidentCommander

OperationsSection

OperationsSection

PlanningSection

PlanningSection

LogisticsSection

LogisticsSection

Finance/AdminSection

Finance/AdminSection

General Staff


General Staff Review

Operations Responsible for determining the appropriate tactics for an

incident Conducts tactical operations, develops the tactical

objectives, and organizes & directs all tactical resources Presents the Incident Action Plan (IAP)

Planning Prepares and documents the Incident Action Plan Facilitates the Operations Briefing

Logistics Provides resources and services required to support

incident activities Finance

Responsible for handling claims related to property damage, injuries, or fatalities

Incident Command System Span of Control

Relates to the supervisory structure of the organization and pertains to the number of individuals or resources one incident supervisor can effectively manage

1-5 is the recommended ratio Organizing resources into Sections, Branches, Groups,

Divisions, Units or Teams when the supervisory ratio will exceed 7 or demobilizing when the supervisory ratio falls below 3.


Maintaining Span of Control

Divide an incident geographically.Example: east and west wing of a hospital

Describe functional areas of operation.Example: decontamination team

Used when the number of Divisions or Groups exceeds the span of control. Can be either geographical or functional.

DivisionsDivisions

GroupsGroups

BranchesBranches

The following supervisory levels can be added to help manage span of control: by organizing resources into Divisions, Groups, Branches or Sections

Include only the functions and positions required to attain the objectives!

Branches that are essential for maintaining hospital operations

Medical Care Branch Responsible for the provision of medical care of the incident

victims and patients already in the hospital examples Infrastructure Branch

Facilitates the acquisition and access to essential recovery resources

Security Branch Responsible for security for facility and staff, liaison

with local agencies Business Continuity Branch

Facilitates the acquisition and access to essential recovery resources

Staging Manager is a new area for Hospital Incident Command

Operations Function Responsible for deploying resources May have several staging areas

Medications Staff (Labor pool) Transportation

Resources within the Staging Areas are available and ready for assignment (rest and repair areas are NOT located at staging)

ICS Communication System

Improves communication – internally and externally Standardizes terminology Allows accountability Two Types of communication

Formal follow lines of authority when• Receiving and giving work assignments• Requesting support or additional resources• Reporting progress on assigned tasks

Informal communication does not follow lines of authority

• Is used to exchange incident or event information only

Allows for documentation on HICS Forms

Chain of Command (Single, Unity)

IncidentCommander

IncidentCommander

Command Staff

General Staff

OperationsSection ChiefOperations





Section ChiefFinance/AdminSection Chief

Finance/AdminSection Chief

HAZMAT BranchDirector

HAZMAT BranchDirector

Medical CareBranch Director

Medical CareBranch Director





Service Branch Director

Service Branch Director

SupportBranch Director

SupportBranch Director

Orderly Line of

Authority Single

Command

Unity of command

Means that each employee answers to ONE supervisorSlide courtesy of FEMA

Single versusUnified Command

Single command

One organization and single IC has complete responsibility for incident (hospital receives victims from train crash)

Unified command

Multiple agencies / organizations share responsibility

Collective / collaborative approach

Single set of objectives for multiple agencies

Improved information flow and coordination

Agencies understand joint priorities and restrictions

Single IAP

Agency 1 Agency 2 Agency 3


Information and Intelligence Within ICS

Establishes a process for gathering, sharing, and managing incident related information and intelligence

Assures that internal information is safeguarded but also ensures availability to those who need it to perform their jobs effectively and safely.

Often handled within Planning, Situation Unit However, in some situations may require:

As a branch within Operations Within the Command Staff As a separate General Staff Section

Briefings/Meetings Features of ICS Essential to ICS for good supervision and

incident management Short concise meetings, no long

discussions or complex decision making Allow manager or supervisor to pass along

specific information and expectations for the upcoming work period

Opportunity to field questions from subordinates related to that information

Types of Briefings/Meetings Staff-Level Briefings: Delivered to

resources assigned to non-operational and support tasks at the Incident Command Post or Base.

Section-Level Briefings: Delivered to an entire Section (e.g., the operational period briefing).

Field-Level Briefings: Delivered to individual resources or crews assigned to operational tasks and/or work at or near the incident site.


Briefings

Clearly stated objectives and the following elements:

Task

What is to be done?

Purpose

Why it is to be done?

End State

How it should look when

done?


Operational Period Briefing(Shift briefing) Conducted at the beginning of each

operational period Facilitated by the Planning Section Chief Operations Briefing is held to introduce IAP

to Branch Directors and Division/Group Supervisors

After the Operational Briefing, the Incident Action Plan is implemented

Schedule for Operations briefing

Planning section chief reviews agenda and facilitates

▼ IC presents objectives (sometimes defers to Planning Chief to present)

▼ Off-going Operations Section Chief – provides current assessment and

accomplishments during last ops period▼

Oncoming Operations Section Chief – covers work assignments and staffing▼

Technical Specialist -Safety Officer – Special Operations –present updates▼

May have specific Unit Leaders present information▼

Final IC comments▼

Planning Section Chief announces next briefing time/location, adjourn

PlanningMeetingDevelop

strategies &tactics to

Accomplishobjectives

ImplementAction Plan

Assess progressusing measuresof effectiveness

ManagementMeeting

Evaluates& revisesincident

objectives

OperationsBriefingBriefs the

operationalleaders on the

Action Plan

Action Planpreparation& approval

Incident ManagerSets overall

incident objectives& priorities

On-goingsituation

assessment& information

processing

Incident isrecognized

Notifications,assessment,Immediate

needsare

addressed

United States Coast Guard

ICS Tools

Emergency Operations PlanHospital Policies and Procedures ManualICS FormsPosition Description and Job Action

SheetsOther resource materials

Are you Ready?

Are you now able to:Explain how the modular organization

expands and contracts?Given a scenario, recognize complicating

factors?Use a planning cycle?Create an incident action plan?

MERET Acknowledges its Partners:

1. Healthcare System Preparedness Program Partnersa. Minnesota Department of Health–Office of Emergency

Preparednessb. MDH Metropolitan Hospital Compactc. Regional Hospital Resource Center Focus Group:

• Michelle Allen, Northwest• Clyde Annala, Northeast• Jill Burmeister, South Central• Chuck Hartsfield, Central• Marla Kendig, Southeast• Emily Parsons, MDH-OEP• Justin Taves, West Central• Eric Weller, South Central

2. FEMA Independent Study Program

Incident Management for Healthcare Operations Based upon Emergency Management Institute ICS-200HC.

Documents

Transcript of Incident Management for Healthcare Operations Based upon Emergency Management Institute ICS-200HC.