How HICS has Changed H ow it will Effect hospitals

1. How HICS has ChangedHow it will Effect hospitals Hospital Summit January 12, 1014

2. Presenter: Barbara Dodge BA-E Center for Preparedness Education HICS Center National Faculty and Revision Workgroup

3. Session Objectives • Discuss how the revision process was undertaken • Describe the changes to HICS and how they will effect your hospital

4. Current status of the revision • Materials have been completed and are being finalized • Not yet formally accepted by California EMS Authority. Release Date: March 2014 • We are not at liberty to “ hand out” the changes however… • We can discuss key concepts and materials associated with the 2013 HICS update

5. HICS Revision • CA EMSA is revising HICS with federal funds in partnership with CDPH, and the United States Department of Veterans Affairs • Convened a revision group: subject matter experts from across the country (John & Barbara were part of that group)

6. HICS Revision • When approved the materials will be available on the HICS Center & California EMSA websites • *** Center for Preparedness Education web site will provide links! ***

7. HICS Revision 2013 • Recognized need for materials to be reviewed and updated based on lessons learned and current promising practices • A Survey Monkey was designed and executed to gauge the use of HICS and recommendations for change

8. The Basic Rules for Change • Continue the core strengths: standardized, flexible and scalable • Comply with current regulations and expectations • Reasonable modifications - not change for change sake • Apply lessons learned • Address emerging issues • Consider the costs of every change – limit the costs of change Make It Better Not Different

9. The Changes • They are NOT as extensive as in 2006 • Where possible the materials were simplified and standardization improved • All of the components will be available in WORD format

10. The Changes • Incident Management Team renamed: Hospital Incident Management Team • Some positions realigned or consolidated based on input from users across the country • Example: One position with responsibility for food provision • Format of the Job Action Sheet was revised to include 4 time periods with tools identified throughout

11. The Changes • Forms were revised and new ones added; consistency with FEMA ICS forms was emphasized • IAP Quick Start to consolidate forms; application in short term response and during off hours • Incident Planning Guide scenarios were revised and expanded • Additional Incident Planning and Response Guides were developed, including: Wild land fire, Active shooter, and Mass casualty incident

12. The Changes • The Guidebook was extensively revised and expanded to focus on the implementation of HICS • Not intended to be a text for the development of an emergency management program • Expanded guidance on use of HICS for small and rural hospitals, off hours and weekends • Addresses the use of the Nursing Home Incident Command System

13. Key HIMT Concepts • It is a comprehensive design, but: • Tailor it to your needs, risks, facility size and operation • Use what you need, when you need it • Most incidents are short lived BUT DO VARY • Combine positions if it makes sense • Still emulates ICS used by external partners

14. Command • Incident Commander • Every incident requires one! • Appoints other command personnel as needed/available • Sets operational period & approves incident action plan • “Facilitates crisis management success” -demeanor/knowledge/decision making • Public Information Officer • Handles media relations • Coordinates internal messaging • Utilizes social media for information gathering and dissemination No Changes

15. Command • Liaison Officer • Link to external partner (s) • Monitors external messages (radio/intranet etc.) • Shares appropriate facility information with others • Safety Officer • Everybody’s job is safety • Their sole focus • Beyond the Incident Commander, the only position that can bring the response actions to a halt • May need more then one person depending on situation No Changes

16. Medical Technical Specialists • Either Medical (i.e. Infectious Disease, Chemical etc.) or Technical (Risk Management, Medical Ethicist etc.) • Some content improvements made in JAS • Still intended to be consultant; can be given line authority if appropriate • Can be personnel in your facility OR… persons you contract with from somewhere else • May report to the Incident Commander or to a Section Chief No Changes

17. Operations • Largest section as before – “Doers” • Same branches as before • Staging remains as before – NOT the same as Labor Pool and Credentialing Unit • Medical Care • Infrastructure • Security • Hazmat • Business Continuity • Patient Family Assistance Branch added under Operations • Focus on patient/victim family members and needs • Social Services and Family reunification addressed

18. Incident Commander Public Information Officer Safety Officer LiaisonOfficer Medical -Technical Specialists Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Administration Section Chief Hospital Incident Management Team (HIMT)

19. Liaison Officer Safety Officer Public Information Officer Operations Section Operations Section Chief Planning Section Planning Section Chief Finance/ Administration SectionChief Incident Commander 2006 Incident Management Team Medical-Technical Specialists Operations Section Logistics Section Chief Staging Manager Resources Unit Service Branch Time Unit Medical Care Branch Infrastructure Branch Situation Unit • Support Branch Procurement Unit Security Branch Hazmat Branch Documentation Unit Comp./Claims Unit Business Continuity Branch Demobilization Unit Cost Unit

20. Liaison Officer Safety Officer Public Information Officer Operations Section Operations Section Chief Planning Section Planning Section Chief Finance/ Administration SectionChief Incident Commander 2013 Hospital Incident Management Team Medical-Technical Specialists Operations Section Logistics Section Chief Staging Manager Resources Unit Service Branch Time Unit Medical Care Branch Infrastructure Branch Situation Unit • Support Branch Procurement Unit Security Branch Hazmat Branch Documentation Unit Comp./Claims Unit Business Continuity Branch Patient Family Assistance Branch Demobilization Unit Cost Unit

21. Logistics • Remains vital to resource management – “ Getters” • Branches remain • Service – Communications/IT-IS • Support – Employee Health and Well Being/Transportation/Supply/Labor Pool and Credentialing • Food unit consolidated under Logistics - Service Branch • Addresses food/refreshment/snack needs for everyone • Employee Family Assistance Unit added to Logistics- Support Branch • Focus is on staff family support: lodging/meds etc.

22. Planning • Importance should not be ignored – “Thinkers and Writers” • Continues to include: • Resources • Situation • Documentation • Demobilization • Remain responsible for development of the Incident Action Plan • More emphasis placed on this important tasks • Too many facilities unaware or don’t understand its purpose and importance No Changes

23. Finance/Administration • Not always there at the beginning but needed at the end – “Payers and Reimbursement Seekers” • Activities remain focused on Time/ Procurement/Compensation- Claims/ Costs • Essential that cost accounting and forecasting starts early and is continued to the end • FEMA reimbursement depends on documentation details and pictures • Section also addresses other general administrative matters No Changes

24. Other Positions/Ideas Discussed • HCC Manager • Insures what’s needed is provided to maintain operation • HIMT Support personnel • Administrative support for those in charge • Combining positions • Each facility needs to make their own decisions what to combine for after business hours, weekends and holidays • Alternate HCC should be identified and exercised • Integration of HIMT with community Incident Command System

25. Guidebook • Extensively revised from 2006 version • Objectives for each chapter • Addresses key topic areas • Introduction to ICS and HICS • Benefits of Using HICS • Hospital Emergency Management • Operationalizing HICS • Hospital Incident Management • Putting It All Together • The HICS Tool Kit Materials • Incident Action Planning • Implementing HICS After Business Hours and for Small and Rural HCFs • Nursing Home ICS • Incident Planning considerations

26. Other Content • Glossary of terms and abbreviations • Resources • Appendices • HIMT Depth chart– more important then ever before • Job Action Sheets • Incident Planning and Response Guides • HICS Forms • Planning Considerations • Glossary • References

27. Job Action Sheets • Remain a valuable HICS tool • Written for each HIMT position • Have been reformatted to provide clearer directions/documentation ease • Should be kept immediately available (pocket, print, computer) for use • SHOULD BE REVISED TO YOUR NEEDS and CAPABILITIES

28. Incident Commander Job Action Sheet

29. Incident Planning and Response Guides • Big hit based on comments • Originally based on 27 NIMS planning scenarios; now revised and consolidated to 16 • Survey showed which ones were used most frequently as well as suggestions for new guide • ____ • ____ • ____

30. Incident Planning and Response Guides • Big hit based on comments • Originally based on 27 NIMS planning scenarios; now revised and consolidated to 16 • Survey showed which ones were used most frequently as well as suggestions for new guide • New:Wildland Fire, Active Shooter, Mass Casualty Incident, Tornado • ___ • ___

31. Incident Planning and Response Guides • Big hit based on comments • Originally based on 27 NIMS planning scenarios; now revised and consolidated to 16 • Survey showed which ones were used most frequently as well as suggestions for new guide • New:Wildland Fire, Active Shooter, Mass Casualty Incident, Tornado • Infant abduction revised to Missing Person; Biological expanded to Infectious Disease • ___

32. Incident Planning and Response Guides • Big hit based on comments • Originally based on 27 NIMS planning scenarios; now revised and consolidated to 16 • Survey showed which ones were used most frequently as well as suggestions for new guide • New:Wildland Fire, Active Shooter, Mass Casualty Incident, Tornado • Infant abduction revised to Missing Person; Biological expanded to Infectious Disease • Infrastructure damage consolidated into Utility Failure

33. Incident Planning and Response Guides • Incident Planning Guide • Begins with a brief scenario covering mitigation through recovery • Mitigation, Preparedness, Response and Recovery sections as before • Can be used to write a plan or review a current plans content

34. Incident Planning and Response Guides • Incident Planning Guide • Begins with a brief scenario covering mitigation through recovery • Mitigation, Preparedness, Response and Recovery sections as before • Can be used to write a plan or review a current plans content • Incident Response Guide • Include response objectives • Expanded content in each time period for key positions • New table highlights recommended positions by time period

35. HICS Forms • Reviewed, revised and improved • Accounts for FEMA changes • Combination still of pertinent FEMA forms and healthcare facility applicable forms • Ordered now by function • In Word format • Intended to be completed long hand or on computer • Still have purpose/origination/distribution in footer • Also accompanied by detailed completion instruction sheet

36. 22 Forms – Revised to new FEMA Format • HICS 200 – IAP Cover Sheet • HICS 201 - Incident Briefing • HICS 202 - Incident Objectives • HICS 203 - Organization Assignment • HICS 204 - Assignment List • HICS 205 - Communications List • HICS 206 - Staff Medical Plan • HICS 207 - Organization Chart • HICS 213 - General Message • HICS 214 - Activity Log • HICS 215A - IAP Safety Analysis • HICS 221 - Demobilization Check out • HICS 251 - Facility System Status Report • HICS 252 - Section Personnel Time Sheets • HICS 253 - Volunteer Staff Registration • HICS 254 - Disaster Patient Tracking Form • HICS 255 - Master Patient Evacuation Tracking Form • HICS 256 - Procurement Summary Report • HICS 257 - Resource Accounting Record • HICS 258 - Hospital Resource Directory • HICS 259 - Hospital Casualty Fatality Report • HICS 260 - Patient Evacuation Tracking Form • HICS - IAP Quick Start .

37. HICS Forms User’s Reference • Forms Grouped by Function: • 2 for General Use • 7 for Incident Action Planning • 5 for HCC Management • 2 for Casualty/Victim Care • 5 for Event Logistics & Finance • 2 for Evacuation |

38. Quickstart Page 1 Name & Operational Period Situation Summary Initial Incident Hospital Management Team Chart Staffing

39. Quickstart Page 2 Health & Safety Analysis Objectives, Strategy/Tactics, Resources, Responsible Person Prepared by

40. Summary • HICS is the most used healthcare based ICS in the US • HICS modifications in 2006 were well received • HICS 2013 builds off the core strengths of earlier version and makes improvements based on lessons learned, new planning and response challenges, and cost considerations

41. Summary • Improvements made to create HIMT and revised job action sheets, incident planning and response guides and HICS forms • Guidebook : describes key planning and response considerations to consider and describes HICS and all the accompanying tools for you to use • New materials will be published later this spring on CA EMSA and HICS Center web sites

42. Barb’s Summary “Don’t worry, Be Happy!”

43. How do you Make it Your Own? • Incorporate HICS and the revisions • Customize HICS to your needs and capabilities