Incident Management Systems for Hospitals

1. Incident Management Systems for Hospitals Kristi L Koenig, MD, FACEP Professor of Clinical Emergency Medicine Director of Public Health Preparedness University of California at Irvine

2. Why Management Aspects? • Incident Management new to health care systems • Not traditionally used in some types of events, e.g. biological, nursing strike • Clinical is relatively familiar • “Emergency Management” unfamiliar to most clinicians • ED is “soft target” University of California at Irvine Department of Emergency Medicine

3. Are We Prepared? • Post 9/11 • Prior Secretary of Department of Homeland Security said “yes!” • Experts quoted in New York Times said “no!” • Lack of Benchmarks University of California at Irvine Department of Emergency Medicine

4. Why do hospitals need to be prepared? • Disaster are Local! • Most casualties arrive to the hospital within 1 ½ hours • Civilian volunteers and local first responders rescue most victims (95%) within first 24 hours • Critical care and trauma surgery managed without State or Federal assistance University of California at Irvine Department of Emergency Medicine

5. Disaster Casualties • Most planning focuses on injuries • Victims need treatment for other conditions • Lack of access to primary care • Exacerbation of chronic conditions • Psychological effects • Increased incidence of childbirth, heart attacks University of California at Irvine Department of Emergency Medicine

6. Sudden Impact EventsStudy of 29 U.S. Disasters • Most trauma victims have minor injuries • Accidents occur during recovery phase • 10-15% of victims hospitalized • Half admitted for non-medical reasons • Sent home next day • 6% supply shortages • 2% personnel shortages University of California at Irvine Department of Emergency Medicine

7. Lack of Resources? • Studies of recent disasters in the US show a lack of a management system to organize available resources • Hurricane Katrina • An exception? University of California at Irvine Department of Emergency Medicine

8. Key Principles • All-Hazard • Hazards Vulnerability Analysis (HVA) • Comprehensive Emergency Management • Mitigation • Preparedness • Response • Recovery • Incident Management System University of California at Irvine Department of Emergency Medicine

9. Why Incident Management Systems for Hospitals? • Continuity of Business Operations Plan • Meet responsibilities to employees, patients, and community • Reduce insurance/workers compensation costs • Protect capital investment • Regulatory compliance • Ultimate goal to reduce morbidity and mortality • JCAHO requirement University of California at Irvine Department of Emergency Medicine

10. JCAHO RequirementsJanuary 2001 • All-Hazard • Hazard Vulnerability Analysis (HVA) • Comprehensive Emergency Management • Community-Wide Planning • Incident Management System • Example - Hospital Emergency Incident Command System (HEICS) • Consistent with community standards University of California at Irvine Department of Emergency Medicine

11. Incident Management System • Command, Control, Leadership • Flexible process for ongoing assessment • Incident Action Plans • Unified Command for multi-jurisdictional events • Federal Level • National Incident Management System (NIMS) • Hospital Level • Hospital Emergency Incident Command System (HEICS) • Change to Hospital Incident Command System (HICS) University of California at Irvine Department of Emergency Medicine

12. Disaster Management AgenciesFederal StructurePre 9/11 University of California at Irvine Department of Emergency Medicine

13. National Incident Management System (NIMS) • Established post 9/11 by Homeland Security Presidential Directive 5 • Ensures all levels of government have capability to work efficiently together using a national approach to domestic incident management University of California at Irvine Department of Emergency Medicine

14. Incident Command System (ICS) • Component of the National Incident Management System (NIMS) • Provides a universal structure and process to manage the organization’s response and recovery activities University of California at Irvine Department of Emergency Medicine

15. External Scenarios • Nuclear Detonation—10-Kiloton Improvised Nuclear Device • Biological Attack—Aerosol Anthrax • Biological Disease Outbreak—Pandemic Influenza • Biological Attack—Plague • Chemical Attack—Blister Agent • Chemical Attack—Toxic Industrial Chemicals • Chemical Attack—Nerve Agent • Chemical Attack—Chlorine Tank Explosion • Natural Disaster—Major Earthquake • Natural Disaster—Major Hurricane • Radiological Attack—Radiological Dispersal Devices • Explosives Attack—Bomb Using Improvised Explosive Device • Biological Attack—Food Contamination • Cyber Attack University of California at Irvine Department of Emergency Medicine

16. Internal Scenarios • Bomb Threat • Evacuation, Complete or Partial Facility • Fire • Hazardous Material Spill • Hospital Overload • Hostage/Barricade • Infant/Child Abduction • Internal Flooding • Loss of Heating/Ventilation/Air Conditioning • Loss of Power • Loss of Water • Severe Weather • Work Stoppage University of California at Irvine Department of Emergency Medicine

17. ICS - Components • Adaptable to any type of emergency • Common organizational/procedural standards • Common Terminology • Integrated Communications • Modular Organization • Unified Command Structure • Maintains autonomy of jurisdiction University of California at Irvine Department of Emergency Medicine

18. ICS - Components • Manageable Span of Control • Consolidated Action Plans • Represent Incident Action Planning Process • Comprehensive Resource Management • Designated Incident Facilities University of California at Irvine Department of Emergency Medicine

19. ICS5 Major Functional Areas • Command or Management • Operations • Planning • Logistics • Finance University of California at Irvine Department of Emergency Medicine

20. University of California at Irvine Department of Emergency Medicine Incident Command Leadership & Direction Authorization of Expenses Planning Address "what if?" Finance / Admin Tracks Expenses Operations ‘Doers' Logistics Supports Operations Requirements

21. Health Care Facilities • Victims arrive unannounced • May not arrive by EMS • Family and friends overwhelm system with inquiries • Volunteers • Media University of California at Irvine Department of Emergency Medicine

22. Health Care Facilities • Convergence of injured persons, relatives & friends, the general public (volunteers), off-duty staff & medical personnel, and media • Not a Scarcity of Resources • Lack of Incident Management System University of California at Irvine Department of Emergency Medicine

23. Critical Hospital Resources • Physical plant • Personnel • Supervision • Supplies and Equipment • Communication • Transportation University of California at Irvine Department of Emergency Medicine

24. Brief History of HEICS • 1980’s – FIRESCOPE • Southern California wildfires use ICS • 1987 - Hospital Council of Northern California adapts ICS to hospitals • 1991 - HEICS I • 1992/93 – HEICS II • 1998- HEICS III • 2006- HEICS IV • August 2006- HICS Guidebook University of California at Irvine Department of Emergency Medicine

25. HEICS I - III • Areas needing improvement • Not NIMS compliant • Medical Officer not directly under IC • Labor pool in Planning, not Operations • Damage assessment in Logistics, not Operations • Operations section • Only focus on medical requirements • Designed around department, not incident functions • No concept of Incident Action Planning • Existed separately from hospital disaster plan University of California at Irvine Department of Emergency Medicine

26. The New HICS • HEICS IV/HICS has different organizational chart • Simpler and smaller • More flexible and adaptable • NIMS compliant • Enhanced Job Action Sheets • Extended operations and recovery sections University of California at Irvine Department of Emergency Medicine

27. HICS Guidebook #1: High-level guidance for developing a hospital Emergency Management Program (EMP) • Key considerations • Planning and response assumptions • Provides guidance for use of the incident command system • Adapted to incident specific situations • Modular and scalable based on availability of personnel University of California at Irvine Department of Emergency Medicine

28. HICS Guidebook #2: A HICS training curriculum • Specific instructional guidance and teaching outlines • Curriculum materials designed to provide variable methods of training hospital staff • Emergency response principles • Incident command University of California at Irvine Department of Emergency Medicine

29. New HICS Elements • A more compact and versatile incident management team structure • Modular • Scalable to the event • Updated Job Action Sheets (JAS) • Revised, National Incident Management System (NIMS) consistent forms University of California at Irvine Department of Emergency Medicine

30. New HICS Elements • Incident Planning Guides (IPG) • Assist in evaluating and writing emergency plans • Scenario based • Incident Response Guides (IRG) • Key considerations and response actions for command staff • Scenario based • Expanded information and tools • Guidebook and Appendices • Resources University of California at Irvine Department of Emergency Medicine

31. HICS Summary • The HEICS IV/HICS project updated HEICS III to current emergency management practices and principles • Developed by hospital and incident command experts • HICS Guidebook assists hospitals in implementation • HICS provides new materials • Job Action Sheets • Incident Planning Guides • Incident Response Guides University of California at Irvine Department of Emergency Medicine

32. Hospital ICS University of California at Irvine Department of Emergency Medicine

33. Command Section • Leadership • Incident Commander • Organize and direct Emergency Operations Center and all positions throughout the ICS structure • Overall direction for hospital operations • Authorizes evacuations University of California at Irvine Department of Emergency Medicine

34. Command (Management) Section • Responsible for overall incident management • Command Staff Positions • Information (Public Affairs) Officer • Safety Officer • Liaison Officer • Single vs. Unified Command University of California at Irvine Department of Emergency Medicine

35. Operations Section • Reduction of immediate hazard • Establish situation control • Restore normal operations • Functions • Staging areas • Resources • Organization of operations divisions, groups, and branches University of California at Irvine Department of Emergency Medicine

36. Operations SectionKey Components • Business Continuity • Equipment • Plant and Utilities • Safety and Security • Health and Medical University of California at Irvine Department of Emergency Medicine

37. Planning Section • Collection, evaluation and dissemination of tactical information about the incident • Maintains information on current and forecasted situation • Tracks status of resources • Primary units • Section chief/deputy, resources unit, situation unit, documentation unit, demobilization unit, technical specialists University of California at Irvine Department of Emergency Medicine

38. Logistics Section • Provide support to incident • Order all resources from off-incident locations • Provide facilities, transportation, supplies, equipment maintenance, fueling, feeding, communication and medical services for responders • Sections • Chief/deputy, supply unit, facilities unit, ground support/transportation unit University of California at Irvine Department of Emergency Medicine

39. Finance Section • Procurement Unit • Time Unit • Compensation/Claims Unit • Cost Unit • Capture costs for FEMA reimbursements during State or Federal disaster declarations University of California at Irvine Department of Emergency Medicine

40. ICS – Translated! • Command/Management…Pointers • Plans………………………Thinkers • Logistics…………………..Getters • Finance……………………Counters • Operations………………...Doers University of California at Irvine Department of Emergency Medicine

41. ICS Functional Responsibility • Command • Strategy, global responsibility • Define mission, ensure completion • Operations • Implement plan, direct tactics • Planning • Collect/analyze data, direct planning • Continuity of operations • Logistics • Support response • Environment and materials • Finance • Track money, ensure documentation • Maximize recovery, reduce liability University of California at Irvine Department of Emergency Medicine

42. ICS Implementation • Unfolds in a modular fashion • Based on incident type and size • Single individual can simultaneously manage all major functional areas or independent management required • Used to plan, organize, staff, direct and control emergency situations University of California at Irvine Department of Emergency Medicine

43. ICS Implementation • Incidents without warning (earthquake, explosion) • Leadership and direction initially provided by any employee who first recognizes the danger • Incidents with warning (severe weather, cloud of hazardous materials approaching facility) • Director or designee provides initial leadership and direction University of California at Irvine Department of Emergency Medicine

44. ICS ImplementationIncident Management Team University of California at Irvine Department of Emergency Medicine

45. Command Post • Consider establishing for incident that involves a distinct scene within the facility or its grounds • Ad-hoc location where decisions are made concerning control of incident University of California at Irvine Department of Emergency Medicine

46. Emergency Operations Center • Pre-designated location within facility • Location where activates related to information collection, inter-service coordination, strategic decision-making and resource allocation are managed • Not all incidents require the use of an EOC University of California at Irvine Department of Emergency Medicine

47. University of California at Irvine Department of Emergency Medicine

48. EOC Activities • Gather information through ongoing assessments • Brief EOC staff • Establish shifts • Set overall objectives for each shift • Determine resource requirements • Develop communications and traffic plans • Keep complete documentation University of California at Irvine Department of Emergency Medicine

49. Life Cycle of an Incident • Event recognition • Incident notification • Situation analysis and monitoring • Emergency Operations Plan (EOP) activation • Operation of the Hospital Command Center (HCC) • Staffing the Incident Management Team • Incident Action Planning • Communication and Coordination • Demobilization • System Recovery University of California at Irvine Department of Emergency Medicine

50. It’s 3 a.m. and Disaster Strikes… • Response Actions • Control the scene • Establish a Command Post • Conduct internal notifications • Develop initial strategy for protecting life and property • Determine what resources are needed to control the problem • Continue to organize and manage the situation until relieved University of California at Irvine Department of Emergency Medicine