Command and Control in Evacuations

1. Command and Control in Evacuations OSHA Training Institute – Region IX University of California, San Diego (UCSD) - Extension OSHA Training Institute

2. Purpose: • To ensure you learn effective training and presentation techniques well enough to become an effective outreach trainer of command and control during health care facility evacuations OSHA Training Institute

3. Objectives • State how the National Incident Management System influences large scale evacuations • Discuss the development of Standard Emergency Management System and how it works in disaster management • Identify how the Hospital Incident Command System (HICS) or Incident Command System (ICS) are used in evacuations • Identify three purposes of HICS or ICS OSHA Training Institute

4. National Response Plan • “At the federal level, the National Response Plan (NRP) provides a framework for how the federal government is to assist states and localities in managing domestic incidents, including both incidents of national significance and those of lesser severity.” GAO Report; GAO-06-826, Congressional Quarterly, Inc. July 20, 2006 OSHA Training Institute

5. National Incident Management System (NIMS) • “…a consistent nationwide approach for federal, state, tribal, and local governments to work effectively and efficiently together to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity.” -HSPD-5 OSHA Training Institute

6. NIMS - Synopsis NIMS What it is not… • Not an operational or resource allocation plan • Not a terrorism or WMD-specific plan • Not designed for international events NIMS What it is… Core set of: • Doctrine • Concepts • Principles • Terminology • Organizational processes • Applicable to all hazards FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005 OSHA Training Institute

7. NIMS • Overall conceptual framework for incident management applicable to all hazards FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005 OSHA Training Institute

8. NIMS Components • Command and Management • Preparedness • Resource Management • Communications and Information Management • Supporting Technologies • Ongoing Management and Maintenance FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005 OSHA Training Institute

9. Relationship: NIMS and NRP National Incident Management System (NIMS) . National Response Plan (NRP) provides support at the Federal level and is activated for events of national significance. Used for all events Incident Local Response State Response or Support Federal Response or Support FEMA. NIMS. SEMS Advisory Committee Meeting, Mather, CA March 2005 OSHA Training Institute

10. SEMS • Standardized Emergency Management System (SEMS) • Developed in California • Local entities must use SEMS in order to be eligible for State funding for response related personnel costs in California OSHA Training Institute

11. The History of ICS • Developed in the 1970s following devastating California fires. • Resulted in deaths, injuries and huge property losses. • Resources and tactical ability were available • Inadequate management resulted in: • Lack of accountability • Poor communication • Lack of a planning process • Overloaded Incident Commanders • No method to integrate interagency requirements OSHA Training Institute

12. SEMS was Developed to Improve: • Coordination between/among agencies • The flow of information and resources • The rapid mobilization, resource tracking and deployment OSHA Training Institute

13. SEMS Framework SEMS includes the: • Incident Command System (ICS) • Multi-agency or inter-agency coordination • Master Mutual Aid Agreement (MMAA) and system • The operational area concept OSHA Training Institute

14. Legal Basis for SEMS in California • Government Code Section 8607 became effective 1993 • The intent of the code is to improve coordination of State and local emergency response in California OSHA Training Institute

15. What Is ICS and HICS? • The Incident Command System (ICS): • Is a flexible standardized, on-scene, all-hazard incident management concept that can be expanded to handle the demands and potential complexities of single or multiple incidents • ICS in healthcare is called Hospital Incident Command System (HICS) and is based on the 2006 version of the Hospital Emergency Incident Command System (HEICS) OSHA Training Institute

16. HICS • Hospital Incident Command System • Organizational core of a crisis management system • Built on the principles and structure of ICS • It is the same crisis management system used by other response agencies • Offers a universal link with outside resources OSHA Training Institute

17. How HICS Works • Chain of command • Common language • Flexibility • Job action sheets • Mutual aid • Documentation for financial recovery OSHA Training Institute

18. Why Use the Incident Command System in the Hospital? • Efficiency • Coordination • Communication OSHA Training Institute

19. ICS Purposes • ICS helps to ensure: • Achievement of tactical objectives • Efficient use of resources • Safety of responders and others Hospital Exercise using HICS OSHA Training Institute

20. ICS Features • Common terminology • Organizational resources • Manageable span of control • Organizational facilities • Use of position titles • Reliance on an Incident Action Plan • Integrated communications • Accountability Slide Credit: FEMA IS100-HC OSHA Training Institute

21. Structure of ICS and HICS • Flexible • Built on successful business practice • Built on decades of lessons learned from the management and organization needed in emergency incidents OSHA Training Institute

22. ICS Structure Incident Commander Safety Liaison Officer Officer Information Officer Finance Logistics Operations Plans OSHA Training Institute

23. Chain of Command Chain of command is an orderly line of authority within the ranks of the incident management organization. Authority There is only one person in charge until replaced by the next qualified person OSHA Training Institute

24. The Span of Control under ICS • The span of control refers to the supervisory structure of the organization and the number of individuals or resources one incident supervisor can manage effectively • The optimal reporting element is 5 elements per supervisor but may vary from 3 - 7 Supervisor Resource 5 Resource 1 Resource 4 Resource 3 Resource 2 OSHA Training Institute

25. Incident Operations Organization Large Incident Small Incident Multiple layers as needed for span of control OSHA Training Institute

26. Management by Objectives • ICS is managed by objectives • Objectives are communicated throughout the entire ICS organization through the incident planning process OSHA Training Institute

27. Reliance on an Incident Action Plan • Every incident should have an Incident Action Plan (IAP) that: • Specifies the incident objectives. • Lists the actions based on objectives • Measurable strategic operations to support the objectives and be achieved within operational period OSHA Training Institute

28. Elements of an Incident Action Plan • Every IAP must have four elements: • What do we want to do? • Who is responsible for doing it? • How do we communicate with each other? • What is the procedure if someone is injured? Slide credit - FEMA IS 100 HC OSHA Training Institute

29. Incident Commander Incident Commander • Only the positions needed are filled to manage the incident. The expansion of incidents may require the delegation of authority to Operations, Planning, Logistics and Finance/Admin sections. Public Information Officer Liaison Officer Command Staff Safety Officer General Staff Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief

30. Incident Commander The Incident Commander • Provides overall leadership for incident response. • Established Command Post • Based on the requirements and complexity of the incident • Delegates authority to others • Takes general direction from agency administrator/official • Assesses need for staff OSHA Training Institute

31. Incident Commander • Establishes incident objectives • Directs staff to develop the Incident Action Plan (IAP) • Is assisted by the Command Staff OSHA Training Institute

32. Public Information Officer • Member of the Command Staff • Conduit between internal and external stakeholders, including media interactions • Public Information Systems are required by National Incident Management System (NIMS) OSHA Training Institute

33. Safety Officer • Member of the Command staff • Monitors safety conditions • Develops measures for assuring the safety of all assigned personnel OSHA Training Institute

34. Liaison Officer • Command Staff • Primary contact for supporting agencies and organizations that are assisting at an incident, but are NOT participating within the ICS OSHA Training Institute

35. HICS Functional Areas • Operations section • Planning section • Logistics section • Finance / Administration section OSHA Training Institute

36. Operations Section Chief • Conducts, develops, directs all tactical objectives, operations and resources • In HICS, the word “tactical” refers to the business of managing patient care and is not a reference to security OSHA Training Institute

37. Operations Section in HICS • Carries out the medical objectives to the best of the staff’s ability • The Medical Care Branch covers • Clinical Care • Ancillary Services • Patient Registration OSHA Training Institute

38. Planning Section Chief • Manages the planning process by gathering, analyzing and disseminating information and intelligence. • Compiles the information that is included in the Incident Action Plan OSHA Training Institute

39. Planning Section • The Planning section also maintains status and situational reports, and patient tracking under the HICS structure OSHA Training Institute

40. Logistics Section Chief • Directs the resources and services required to support incident activities • May include ensuring personnel have a place to rest, are fed, have medical support, communications and transportation OSHA Training Institute

41. Logistics Section • The Labor Pool is managed under the Logistics Section in HICS. This is a change from the previous structure in which the labor pool was the responsibility of the Planning Section. Staging Area/Labor Pool is the location where personnel and equipment are staged while waiting for tactical assignment OSHA Training Institute

42. Finance/Administration Section Chief • Manages costs related to incident • Performs accounting, procurement, time payroll recording and cost analysis • Funds medical objectives under HICS • Documents costs to maximize financial recovery and reduce liability OSHA Training Institute

43. Accountability Principles in ICS • Check-In • All responders must report in and assignments are given in accordance with the procedures established by the Incident Commander • Incident Action Plan • Response operations must be coordinated as outlined in the Incident Action Plan • Unity of Command • Principle that each individual will be assigned to only one supervisor FEMA IS - 100-HC OSHA Training Institute

44. Check-In Purpose • Accounts for personnel. • Tracks resources • Prepares personnel for assignments • Locates personnel in case of an emergency • Organizes the demobilization process OSHA Training Institute

45. Summary • NIMS is an overall conceptual framework for incident management applicable to all hazards • NRP provides a federal framework to assist states and localities during disasters • ICS is flexible, can handle large or small events • HICS is ICS in a healthcare setting and will be used in evacuations OSHA Training Institute

46. References • FEMA. National Incident Management System. SEMS Advisory Committee Meeting, Mather, CA March 24, 2005. Slide Set • FEMA National Incident Management System (NIMS), An Introduction IS – 700. http://training.fema/gov • Homeland Security. Quick Reference Guide for the National Response Plan May 22, 2006, Version 4.0 OSHA Training Institute