Incident Command System and National Incident Management System for FQHCs

1. Incident Command System and National Incident Management System for FQHCs Amelia Muccio Amuccio@njpca.org Director of Disaster Planning NEW JERSEY PRIMARY CARE ASSOCIATION

2. Name Job Title Organization Experience in emergencies & disasters Knowledge of IS 100, 200 and 700 Grant funded for EP Expectations from this course . Introductions

3. Panic, fear and denial are inevitable in a disaster situation Brain will perform best in a stressful situation if you have already put it through a few rehearsals I.E. fire drills Brain works in pattern recognition (respond quicker) The Human Condition: “It Cannot Happen to Me!”

4. Personal Preparedness Do you have a family communications plan? Do you have a go bag? Do you have a pet go bag? Have you made arrangements for childcare if you are needed at work? What about your other family members including elderly and pets? . Foundation to Professional Emergency Mgt

5. Be Prepared! .

6. Objectives/Competencies Today • HVA/EMP/COOP & other emergency plans • Incident Command System • Command and control • Functional positions and areas • Leadership • The Planning “P” • NIMS • Multiagency Coordination Systems • Public Information Systems • Resource Mgt • Federal Guidelines/Tools • NPS/TCL/UTL

7. Pubic health agencies and healthcare organizations must learn and use ICS in order to be able to integrate into the larger emergency management system. Including FQHCs . ICS Overview and the Emergency Management Program

8. A comprehensive CEM addresses all hazards through the four phases: Mitigation (including prevention) Preparedness Response Recovery ICS is used for response and recovery phases as well as for preparedness pre-planning activities. . Comprehensive Emergency Mgt Program

9. CEM-4 Phases • Mitigation (including prevention): reduce or eliminate impact of hazards (generators) Every $1 on mitigation saves $7 in post-disaster costs • Preparedness: build capabilities to respond and recover from the impacts of those hazards (this training) • Response: gain control over on-going negative effects of the hazards (staying open) • Recovery: return to pre-disaster condition (normal business operations) Where should FQHCs focus their efforts? M+P>R+R

10. Emergency Management Plans • EMP is comprehensive, self-contained document that includes the components necessary to guide all emergency activities. • Is essential to minimize the disruption of services • Ensure predictable staff behavior during an emergency • All-Hazards approach • Review ESF #8 • EMP should be aligned and integrated in local and State EMPs “unified front.”

11. Risk Assessment/HVA • BASED ON HAZARD VULNERABILITY ANALYSIS • Identifies potential emergencies and the direct/indirect effects these emergencies may have on CHC’s operation and demand for services. • The risks identified should be prioritized based on likelihood of occurrence and severity.

12. What Are Your Center’s Hazards? • List 3-5 possible hazards that can impact your Center…

13. Certification of plan approval Record of plan and annex revisions EMP distribution list Introduction Phases of emergency mgt Scope Responsibility HVA Schedule of exercises Corrective Action Plan Operational Policies Legal basis and references Command and control Emergency response training Continuity of Operations Support FQHC’s EMP Elements (Emergencies Happen-NACHC)

14. Other Emergency Plans • EOPs-how org will respond to emergencies • Basic plan • Functional annexes • Incident-Specific appendices • Procedures-SOPs • Preparedness plans-training needs • Corrective action/mitigation plans-activities required to implement lessons learned • Recovery plans-long term actions needed

15. EP Rules and Regs • HSPD 5 (NRF and NIMS) • HSPD 7 • HSPD 8 (National Preparedness Goals includes healthcare orgs) • Joint Commission • NFPA 1600 2007 (9/11 Comm.) • HRSA PIN 2007-15 • FEMA’s PS Prep • Executive Order #50

16. National Preparedness Guidelines • National Planning Scenarios—15 high consequence threat scenarios for gov’t and private sector • Universal Task List—menu of 1,600 unique tasks than can facilitate efforts to prevent, protect against, respond to, and recover from NPS; common voc and key tasks that support development of essential capabilities • Target Capabilities List—defines 37 specific capabilities that communities, private sector, and all levels of gov’t should collectively possess in order to respond effective to disasters

17. National Planning Scenarios (15) • Improvised nuclear device • Aerosol anthrax • Pandemic influenza • Plague • Blister agent • Toxic industrial chemicals • Nerve agent • Chorine tank explosion • Major earthquake • Major hurricane • Radiological dispersal device • Improvised explosive device • Food contamination • Foreign animal disease • Cyber attack

18. Elements of Capability • Planning • Organization and leadership • Personnel • Equipment and systems • Training • Exercises, evaluations, and corrective actions

19. TCL (Common Mission Area) • Communications • Community preparedness & participation • Planning • Risk Mgt • Intelligence/Information sharing and dissemination

20. TCL (Prevent Mission Area) • CBRNE detection • Information gathering and recognition of indicators and warnings • Intelligence analysis and Production • Counter-Terror investigations and law enforcement

21. TCL (Respond Mission Area) • Animal health emergency support • Citizen evacuation and shelter-in-place • Critical resource logistics and distribution • Emergency operations center mgt • Emergency public info and warnings • Environmental health • Explosive device response operations • Fatality mgt • Fire incident response support • Isolation and quarantine

22. TCL (Respond Mission Area) CON’T • Mass care (shelter, food, related services) • Mass prophylaxis • Medical supplies mgt and distribution • Medical surge • Onsite incident mgt • Emergency public safety and security response • Responder safety and health • Emergency triage and pre-hospital treatment • Search and rescue (land-based) • Volunteer mgt and donations • WMD/Hazardous materials response and decontamination

23. TCL (Protect Mission Area) • Critical infrastructure protection • Epidemiological surveillance and investigation • Food and agriculture safety and defense • Laboratory testing

24. TCL (Recover Mission Area) • Economic and community recovery • Restoration of lifelines • Structural damage assessment

25. National Priorities HSPD 8 • Expand regional collaboration • UASI • Implement NIMS and NRF • HSPD 5 • Implement NIPP • CI/KR, IS 860 • Strengthen information sharing and collaboration capabilities • TCL metrics • Strengthen interoperable and operable communications capabilities • TCL metrics, SAFECOM • Strengthen CBRNE detection, response and decon • TCL metrics

26. National Priorities Continued“strengthen medical surge and mass prophylaxis capabilities” • Bioterrorism, pandemic influenza and other public health emergencies • Medical surge is prioritized b/c of urgent need to enable our healthcare system to handle large number of patients requiring care • The ability to triage and provide decontamination • For mass casualty event that exceeds hospital's surge community based healthcare systems must have provisions in place to immediately accommodate an influx of patients and supplies • Staffing for mass prophylaxis plan • Strategic National Stockpile • National BT hospital preparedness program

27. National Priorities Continued • Community preparedness: strengthening planning and citizen capabilities • TCL metrics • Lessons learned from Hurricane Katrina

28. Incorporate the safety and security of people and assets into business plans and corporate strategies Participate in the development and implementation of the mgt and maintenance structure and process for the Guidelines, including capabilities based preparedness tools and assessment system Participate in Guidelines implementation by determining requirements and achieving capabilities and by consulting in the development of program plans Participate in State, local, tribal, territorial and regional planning and assessment process to comply with Guidelines and TCL . Private Sector—HSPD 8

29. . Private Sector—HSPD 7 • Work with relevant SSAs (Sector-Specific Agencies) to identify, prioritize and coordinate the protection of critical infrastructure and key resources in conformance with the NIPP • Share info about physical, and cyber threats, vulnerabilities, incidents, potential protective measures and effective practices

30. FQHCs • Role of Private Sector (FQHCs)* • At risk individuals • Special planning considerations (barriers/obstacles) • HVA • Identify hazards • Prioritize hazards • Develop plan to mitigate hazards • COOP • Develop plan for continuity of operations during an emergency • Uninterrupted medical services • Essential staff • Vital records • Facilities and alternate site

31. What is the Incident Command System? • Incident-Focused organizational structure that can be implemented along side of day-to-day administrative structure of an organization • Allows its users to adopt an integrated organizational structure to match the demands of the incident • Based on best practices • Promotes incident safety • Achievement of tactical objectives • Efficient use of resources • 3 Priorities of ICS • Life Saving • Incident Stabilization • Property Preservation

32. ICS • Interdisciplinary (various responders meld rapidly into a common mgt structure) • Organizationally flexible • Cost-Effective (reduces duplication) • Incidents (small or large—planned or unplanned) • Key feature in NIMS

33. California, 1970’s FIRESCOPE Series of catastrophic fires Inadequate management greatest failure in response . ICS’s origin

34. Lack of accountability Poor communication Lack of a planning process Overloaded Incident Commanders Non-Integration . Weaknesses in Incident Mgt without Proper ICS

35. National Response Framework (NRF) • National, all discipline, all hazards plan that provides the framework and mechanisms to coordinate Federal, State, local, Tribal, private sector, and non-governmental entities during national emergencies. • NRF is based on functions • Incident of National Significance, HSPD #5, Stafford Act • Emergency Support Functions (HHS #8)

36. SEMS • SEMS is intended to standardize response to emergencies involving multiple jurisdictions or multiple agencies. • SEMS is intended to be flexible and adaptable to the needs of all emergency responders in California. • SEMS requires emergency response agencies use basic principles and components of emergency management including ICS, multi-agency or inter-agency coordination, the operational area concept, and established mutual aid systems.

37. Key Features of ICS • Common terminology • Modular organization • Management by objectives • Reliance on IAP • Chain of command/unity of command • Unified command • Manageable span of control • Predesignated incident locations and facilities • Resource management • Information and intelligence management • Integrated communications • Transfer of command • Accountability • Dispatch/Deployment

38. Plain English, clear text No jargon No use of day-to-day titles Common Terminology Organizational functions, incident facilities, resource descriptions, position titles What is wrong with acronyms and slang? Bus? Line? . Standardization

39. Use of Title Positions • Provides a common standard for performance expectations • Helps to ensure that qualified individuals fill positions • Standardizes communication and reduces confusion • Describes the responsibilities of the position • No day-to-day titles

40. Command • Establishment: IC assumes command • Transfer of command: more qualified, incident changes, normal turnover, conclusion (effective time and date of transfer) • Chain of command: orderly line of authority • Unity of command: Report to only one supervisor • Unified command: Multiple agencies working together; one set of objectives, Incident Commanders make joint decisions, improved information and optimized effort

41. Planning/Organization Structure • Management by objectives: ICS is managed by objectives based on 3 priorities • Incident Action Plan (IAP): specifies incident objectives and states activities to be completed, covers operational period, written or oral • Modular organization: top-down modules based on incident size and complexity (use only what is needed) • Manageable span of control: number that one supervisor can handle for effective and efficient mgt (3-7) 5 optimal

42. Facilities and Resources • Comprehensive resource management: categorizing, ordering, dispatching, tracking and recovering resources (personnel, teams, equipment, facilities, supplies) • Tactical (assigned, available and out of service) and support resources • Incident locations and facilities: • ICP-on scene command but out of harms way • Base-primary Logistics (one) • Staging area-ready resources awaiting assignment (labor pool, equip, cars) • Camp-separate from base and provides support services (can use camp if base is not accessible) • Helibase/Helispots

43. Communications/Information Mgt • Integrated communications: • Common interoperable communication plan (modes, planning and networks) • Information and intelligence management: • Critical info for response (gather, share and manage info) • Weather info, risk assessments, surveillance)

44. Professionalism • Accountability • Check-in (locate in emergency) • IAP • Unity of command • Span of control • Resource tracking • Dispatch/Deployment • Situation assessed • Manage resources safely and only when requested

45. Check-In once (Form 211) Report to Supervisor to obtain initial incident briefing (current situation, job responsibilities, location of work, procedures, safety info) Ensures accountability, track resources, prepare personnel and locate personnel in case of an emergency . Check-In

46. Stage of initial response, the initial ICS organization takes shape based on the type of incident Predesignated level of staffing . Mobilization

47. ICS Structure .

48. Unified Command (UC with One Command and Multiple IC)*** • There is more than one responding agency with incident jurisdiction • Incidents cross political jurisdictions • Analyze intelligence information • Establish a common set of objectives and strategies for a single IAP

49. Area Command (AC with multiple ICP) • Oversee the mgt of multiple incidents that are each being managed by an ICS org • Oversee the mgt of large incidents that cross jurisdictional boundaries • Public health emergencies (nonsite specific, not immediately identifiable, evolve over time) • AC sets overall strategy, allocates critical resources, ensures compliancy to strategies AC may become Unified Area Command when incidents are multijurisdictional or involve multiple agencies • AC has no Operations Section b/c Operations are conducted on scene

50. At scene, highest ranking person can either assume command, maintain command as is, or transfer command to a third party. . Incident Commander