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.
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
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
Public InformationOfficer
Command Staff
IncidentCommander
IncidentCommander
OperationsSection ChiefOperations
Section ChiefPlanning
Section ChiefPlanning
Section ChiefLogistics
Section ChiefLogistics
Section ChiefFinance/AdminSection Chief
Finance/AdminSection Chief
General Staff
IncidentCommander
IncidentCommander
Slide courtesy of FEMA
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
Photos courtesy of FEMA
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
Slide courtesy of FEMA
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
Slide courtesy of FEMA
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
Slide courtesy of FEMA
Command Staff Review The Incident Commander may need to
designate staff who can provide information, liaison, and safety services for the entire organization
SafetyOfficerSafetyOfficer
LiaisonOfficerLiaisonOfficer
Public InformationOfficer
Public InformationOfficer
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
SafetyOfficerSafetyOfficer
LiaisonOfficerLiaisonOfficer
Public InformationOfficer
Public InformationOfficer
Command Staff
IncidentCommander
IncidentCommander
OperationsSection
OperationsSection
PlanningSection
PlanningSection
LogisticsSection
LogisticsSection
Finance/AdminSection
Finance/AdminSection
General Staff
Slide courtesy of FEMA
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.
Slide courtesy of FEMA
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 ChiefPlanning
Section ChiefPlanning
Section ChiefLogistics
Section ChiefLogistics
Section ChiefFinance/AdminSection Chief
Finance/AdminSection Chief
HAZMAT BranchDirector
HAZMAT BranchDirector
Medical CareBranch Director
Medical CareBranch Director
SafetyOfficerSafetyOfficer
LiaisonOfficerLiaisonOfficer
Public InformationOfficer
Public InformationOfficer
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
Photos courtesy of FEMA
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.
Slide courtesy of FEMA
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?
Slide courtesy of FEMA
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
Top Related