The Incident Command System

1. The Incident Command System Charles Stewart MD EMDM

2. Federal Response State Response State Emergency Management DISASTER SITE Local Response Local Emergency Management ICS – Incident Command System President UnifiedCommand FEMA IncidentCommand

3. An Organized Response • Requires planning • Coordinates resources and personnel • Find a video that shows an organized response

4. Key Principles of NIMS ICS • Span of Control • Unity of Command • Accountability • These are basic principles that have been tested in combat and proven to be necessary for successful accomplishment of a mission

5. What is Span of Control? Span-of-Control means that one person can only supervise 3-7 people and/or be responsible for 3-7 functions effectively.

6. Supervisor 1 2 3 4 5 “Span-of-Control” Refers to number of subordinates that one supervisor can manage effectively. • Ideal ratio is 5-to-1 • ICS structure can expand or contract to maintain adequate span-of-control by adding/removing sections, branches, divisions, groups, teams.

7. What is Unity of Command? Unity of Command means that you answer to only one person for tasks and assignments.

8. Unity of Command • Each person reports to only one individual • ICS organizational chart indicates who that is • What would you do if someone other than your assigned supervisor asks you to do something other than what you were assigned?

9. What does Accountability Mean? • There are two types of Accountability: • You know who is on-scene/site, where they are, what they are assigned to do and if they are safe. • Each person does what they were expected to do.

10. Accountability: People • It is the responsibility of the incident commander to know who is on-scene, to make sure they are doing what is needed and “No one is left behind” • Check In • No freelancing • Report to supervisor • Check Out/Demobilize

11. Responder Etiquette Report to a staging area, not the disaster site

12. Accountability: Task • Give clear assignments • Ensure assignment is understood • Provide adequate resources • Task Completion

13. Report to Staging Area • Sign in when you arrive; Sign out when you leave • Bring ID, credentials • Find your designated supervisor • Follow directions • If asked to leave or provide care elsewhere – do so Medical volunteers at staging area

14. Incident Command System • Used to organize multiple groups/agencies into one cohesive team • Responses and responders may vary, but the organizational principles of ICS remain the same

15. Initiating ICS When an event occurs, initial actions should include: • Scene size up – safety • Assume/Announce Command (Even if you are the only person on scene) • Initially organizing the response – Assign Tasks • Notifying affected agencies (hospitals, LE, Fire/EMS) • Maintain Command role until Command is transferred

16. ICS Characteristics • Critical Characteristics of ICS (7 of 14) • Common Terminology • Management by Objective • Chain of Command/Unity of Command • Resource Management • Integrated Communications • Manageable Span of Control • Accountability of personnel and resources

17. Basic Military Command Structure Commander Executive OfficerXO CommandSergeant Major S1 Personnel S2 Intelligence S3 Operations S4 Supply S6 Signals Surgeon S5 Civil-Military Operations

18. Incident Commander Public Information Officer Safety Officer Liaison Officer Operations Section Chief Planning Section Chief Logistics Section Chief Finance Section Chief Branch Director Division/Group Supervisor Basic ICS Organizational Structure

19. Incident Commander Safety Officer Medical Branch Director Technical Rescue Triage Group Supervisor Treatment Group Supervisor Dive Team Transport Group Supervisor. Extrication Team Small Scale On-Scene ICS

20. Incident Commander Cindy Triage Group Supervisor Paula Treatment Group Supervisor Dr. Jones Transfer Group Supervisor Bob Communications Unit Leader Bob Red Yellow Green Emergency Dept ICS

21. Incident Commander (CEO) Safety Officer (Facilities Manager) Public Information Officer (Marketing Director) Liaison Officer (Nursing VP) Operations Section Chief (House Supervisor) Planning Section Chief VP Logistics Section Chief (Stores and Distribution Mgr. Triage Group Supervisor Treatment Group Supervisor Transport Group Supervisor. Larger Scale Hospital ICS

22. Mobilization of Resources What resources are available to my community during an MCI?

23. Predicting Casualty Flow

24. Local Resources • Ground Ambulances • Air Ambulances • Fire/Rescue Vehicles • ED beds • Hospital beds • Operating Rooms • Blood Supply • Imaging/Lab Capacity • Ventilators • EMTs • Flight Crews • Firefighters • MDs, RNs • RNs, CNAs • Surgeons, OR Crews • Blood Bank Staff • Imaging/Lab Staff • Resp Therapists

25. External Resources • Refer to the “External Resources” handout in your packet: • Regional (ChemPaks, Antibiotics, Antivirals) • State (MCI trailers in Helena, MHMAS ) • Federal (DMAT, SNS, FEMA)

26. ICS/MCI Roles & Responsibilities • Every incident must have an Incident Commander. • In the next few slides we will describe the positions/functions within the Incident Command System critical to managing multiple casualty incidents.

27. Key ICS Roles in a MCI • IC – Every incident must have an IC • Medical Branch Director – Only if the incident is big enough and you have the resources to fill the position. • Triage Group Supervisor • Treatment Group Supervisor • Transport/Transfer Group Supervisor • Rescue or Decon Group Supervisor

28. The Incident Commander • Role: • Assumes and announces command • Leads response effort

29. IC Responsibilities: • Assess incident and communicate an Incident Action Plan (IAP) • Ensure the safety of responders • Request additional resources • Develop organizational structure that effectively manages incident (Assign, Delegate) • Develop plans that stay ahead of the need for resources • Maintain Command until Command is transferred.

30. Assessment and Care of Multiple Patients On-Scene • Rescue/Extrication • Triage • Treatment • Transport Hospital • Decon • Triage/Re-Triage • Treatment • Admission/Discharge/Transfer

31. Medical Branch Director Responsibilities • Takes the medical burden off the IC or Operations Section Chief • The Medical Branch Director assigns and supervises the triage, treatment and transfer group supervisors • The Medical Branch Director reports to the Operations Section Chief or the IC

32. Rescue Group(s) • This and triage are happening simultaneously – in concert with each other. • Extrication • Technical Rescue • Dive Teams • HazMat Decon • Patient Movement (out of hazard zone to patient collection area/treatment tarps)

33. On-Scene Triage Responsibilities: • Size up number and acuity of patients • See each patient rapidly and categorize using a standard triage system • Document the triage category assigned • Communicate (with who) the order of treatment (who needs help first?)

34. Hospital Triage Responsibilities: • Identify the location(s) where triage will occur • Ensure safe access and egress • Anticipate self transporting patients • Implement hospital MCI triage protocol* • Communicate / document triage decisions to Treatment Group

35. Scene Treatment Responsibilities: • Locate a suitable treatment area and report that location to Triage Group Supervisor and Command. • Evaluate resources required for patient treatment, and report those needs to Command • Provide suitable “immediate” and “delayed” treatment areas. • Assign, direct, supervise, and coordinate personnel within your group. • Allocate resources. • Provide lifesaving basic life support before advanced life support. • Match patient needs with provider skills • Report progress to Command

36. Hospital Treatment Responsibilities • Provide definitive care: identify and fix the problem • Provide lifesaving basic life support before advanced life support. • Organize care providers into efficient teams • use ICS principles to maintain control. • Match patient needs with provider skills. • Use available resources, making decisions about resource allocation at each step. • Use tools to document and aid organization • Transport/Transfer/Admit them to the place where these needs can be met.

37. Scene Transport Responsibilities: • Establish/communicate location of ambulance staging (if Command has not already done so) and patient loading areas. • Report resource requirements to Command • Establish/manage a helicopter landing site if warranted • Communicate with Command and Hospitals to obtain medical facility status and treatment capabilities. • Supervise assigned personnel • Coordinate with other divisions/groups • Efficiently and safely move patients to the next location in the continuum of care while providing for their medical needs enroute. • Report progress to Command

38. Hospital Transfer Responsibilities • Communicate with treatment group supervisor for information about patients who need transfer to other facilities • Determine the number and type of transportation resources needed and available. • Arrange transport to referral centers (stage resources early?) • Stage resources until needed • Efficiently and safely move patients to the next location in the continuum of care while providing for their medical needs enroute. • Communicate with receiving facilities to determine capacity and provide advance information

39. Staying Organized • Organizational Tools • Plans • Protocols • Forms • Job Action Sheets

40. Break