Transcript Incident Management for Healthcare

Incident Management
for Healthcare
Operations
Based upon Emergency
Management Institute ICS-200HC
Minnesota Emergency Readiness
Education and Training Program
(MERET)
MERET worked
with partners in
Minnesota to
adapt curriculum
to support the
Hospital Incident
Command System
(HICS) training
MERET is a program designed to educate and train Minnesota’s
health care workers in emergency preparedness, tailoring efforts
to the unique needs of specific communities as they prepare for
a health emergency or bioterrorism event. MERET is funded by
the Office of the Assistant Secretary for Preparedness and
Response (ASPR) of the U.S. Department of Health and Human
Services, and is administered by the University of Minnesota
Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN,
at the School of Nursing, is the Principal Investigator.
Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the
Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum
Development Program.
Objectives
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Name the four (4) phases of comprehensive incident
management.
Recognize how objectives shift from the initial
response phase to the extended response phase.
Name the order in which the Hospital Incident
Command System (HICS) is usually activated.
Select the forms used by the Command and General
Section Chief staff.
Identify the role of the Incident Commander.
Select the appropriate span of control for any
leadership position in the HICS.
Identify the purpose of the Incident Briefing.
Imagine the role you will play
in your facility during this
presentation
Scenario
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30 minutes ago, a tornado warning was
issued for a projected touchdown in this
community
It is now 6:08 am, storm related injuries
have been coming in from surrounding
areas. One injured patient is in the OR
Scattered power outages are being reported
in the area
Lights are flickering in the hospital
There is a roar and the entire facility shakes
momentarily
How you would respond?
□ Too busy - it’s 6:08 am and a shift change will
happen in 60 minutes. Day shift can deal with
this.
□ Panic - realize that you don’t know anything
about the hospital’s Emergency Operations
Plan or where to find it.
□ Reassign the most experienced ICU nurse to
open the Command Center.
□ Call the on call administrator for back up and
begin an immediate plan of action
Incidents Require you to …..
4 Phases of Comprehensive Incident Management
(CEM) Activities for “all hazard” planning
Notification
Response
Preparedness
Mitigation
(Prevention)
Recovery
Examples
Mitigation
Preparedness
(including prevention)
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Prevention
activities that
reduce impact of 
hazard
Example: build
dikes to prevent
flood
Conduct public
health surveillance,
testing
immunizations and
quarantine for
biological threats
Build response
capacity/capability
Example: buy dike
plugs
Response
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Recovery
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Gain control of an
event
Examples: plug dike 
when a hole appears,
Emergency shelter,
housing, food & water
Search and rescue
Evacuation
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Emergency medical
services
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Return to predisaster state
Examples:
Repair/replacement
of dike, damaged
public facilities
(bridges, schools,
hospitals)
Debris cleanup &
removal
Temporary housing
NIMS slide adaptation
Incident progression
BOOM!
Reactive Phase
Recognition
Notifications
Initial control and
safety actions
Establish ICP
Primary Tools
SOPs
Job Action Sheets
Primary Goal
Prevent incident expansion
Prevent responder injury
Proactive Phase
Situation assessed
Objectives established
Strategies / tactics
Resources requested
Primary Tools
ICS
Incident Action Planning
Primary Goal
Manage incident
Slide courtesy of John Hick Hennepin County Medical Center
Getting Organized…
Nature
Size
Day of the Week
Initially
Location Time of Day
Command
Post
Incident
Action
Planning
What ?
Where ?
When ?
Who’s Involved ?
Where Is It Going ?
INCIDENT BRIEFING
Mobilization
• Date/time of start of incident
Checklist
• Type of incident
• Services involved
• Current incident status
• Current resource status
• Current strategy/objectives
• Communications systems being used
• Special problems/issues
Slide courtesy of VA Emergency Management Training Curricula
Incident Complexity Analysis
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Safety issues
Impacts to critical operating systems
Potential need to evacuate
Potential need to relocate services
Impact on essential resources and
suppliers (e.g.: water supply)
Event is due to criminal action
Impact on organization’s reputation
Photos courtesy of FEMA
Managing by Objectives
Incident Action Plan (IAP)
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There is only one Incident Action Plan at an incident which
identifies
 WHAT must be done?
 WHO is responsible?
 How information will be COMMUNICATED?
 What if a responder is INJURED?
Overall Priorities
• Life Saving
• Incident stabilization
• Property Preservation
Establish Incident Action Plan objectives, strategies, tactics
IMS Feature:
Incident Action Plan (IAP)
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Reflects the overall strategy for managing an
incident within a prescribed timeframe – the
operational period (e.g.: 7am-7pm)
IAP is primary source of objectives for action
IAP often includes list of resources and
assignments
IAP may initially be verbal, but should become
written soon in the process
Monitors response to adjust for next period
Documents results
IAP Establishes Objectives,
Strategies, and Tactics
Incident
Objectives
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Establish the general plan or
direction for accomplishing the
incident objectives (IC)
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Specify how the strategies will
be executed. (Operations)
Strategies
Tactics
State what will be
accomplished (agency exec
and IC)
Slide courtesy of FEMA
Operational Times
Initial response phase
Extended response phase
Initial Response Phase
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Operational periods
set by IC usual
breakdown
Immediate 0-2 hours
Intermediate 2-12
Extended over 12
hours
Initiate planning cycle
Extended Response Phase
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Incident requires
additional operational
period (incident
duration>8-12 hour)
Determined by
 Situation
assessment
 Incident action
planning
 Resource
management
Incident Action Planning
Forms to include in the IAP
HICS 201: Incident Briefing (may serve
as initial IAP)
 HICS 202: Incident Objectives
 HICS 203: Organization Assignment List
 HICS 204: Branch Assignment List
 HICS 205: Incident Communications Log
 HICS 206: Staff Medical Plan
 HICS 261: Incident Safety Analysis
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HICS 201 Form (Incident Briefing)
1. Incident Name,
2. Date of Briefing
3. Time of Briefing
4. Event History
5. Current Actions
6. Summary
7. Current Organization
8. Notes
(Accomplishments,
Issues, Directives)
9. Name of the
individual who
prepared the
document
10. Facility Name
HICS 202 Form (Incident Objectives)
1. Incident name
2. Date prepared
3. Time prepared
4. Operational period ( date & time)
5. General command & control objectives
for the incident (including
alternatives)
6. Weather/environmental implications
during the period (forecast, wind
speed/direction, daylight)
7. General safety/staff messages to be
given
8. Attachments (ex. medical plan, facility
system status)
9. Name of the individual who prepared
the document
10. Approval of the Incident Commander
11. Facility name
Job Action Sheets (JAS)
1. Title
2. Purpose
3. To whom they report
4. Critical action
considerations
5. Forms required by
the job
6. Broken into
operational periods
JAS “prompts” the team
member to take needed
actions related to their
roles and responsibilities
Incident Commander
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The Incident Commander performs all
major ICS command and staff
responsibilities unless delegated and
assigned.
Public Information
Officer
Incident
Incident
Commander
Commander
Liaison
Officer
Command
Staff
Safety
Officer
Operations
Section Chief
Planning
Section Chief
Logistics
Section Chief
Finance/Admin
Section Chief
General
Staff
Slide courtesy of FEMA
Delegation of Authority
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An Incident Commander's scope of
authority is derived:
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From existing responsibilities or agreements
Through a delegation of authority from the
agency administrator or elected official in
writing or verbally
Grants authority to carry out specific functions
and provides overall objectives / guidance
Allows the Incident Commander to assume
command.
Does NOT relieve the granting authority of the
ultimate responsibility for the incident.
Delegation of authority comes from the
governing board of your agency
Hospital CEO
Incident
Commander
Photos courtesy of FEMA
Incident Commander
Review
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Provides overall leadership for incident
response
Only position ALWAYS staffed
Delegates authority to others
May appoint deputy if needed
Initial IC holds post until they delegate the
post to another qualified / more qualified
person
Approves IAP and all major resource requests
Incident Commander
Leadership Responsibilities
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Ensures safe work practices
Takes command
Motivates responders
Demonstrates initiative by taking action
Communicates by providing specific
instructions and asking for feedback
Supervises the scene of the action
Evaluates the effectiveness of the plan
Understands and accepts the need to be
flexible, modify plans
Transfer of CommandReview
The process of moving the responsibility
for incident command from one Incident
Commander to another
Occurs when
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More qualified person / team arrives
End of operational period / extended incident handoff
Always includes transfer of command briefing
• Current situation
• Response needs
• Available resources
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All personnel will be informed of the
effective time and date of the transfer of
command
Modular Organization
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The modular/flexible organization structure of the ICS allows
standardization of positions and number of positions
depending on the extent of the incident
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ICS organizational structure should
include only the functions and
positions needed to
achieve the incident objectives
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ICS positions may not be combined in order to save on
staffing or achieve a higher level of efficiency
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ICS recognizes that an Incident
Commander is always necessary no
matter what other additional positions
are assigned
Slide courtesy of FEMA
Activation of Organizational
Elements
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Organizational elements
may be activated without
activating the Section
Chief.
In this case, the unit
reports to the IC directly
Deputy positions can be
found for the Incident
Commander, Branch and
Section Chiefs
Incident Commander
Safety Officer
Operations Section
Situation
Unit
Rescue
Group
Medical Group
Slide courtesy of FEMA
Things To Avoid
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Do not combine ICS positions to save on staffing.
Individuals may supervise multiple units, but the
positions should remain distinct.
Bob
Bob
Supply and
Facilities
Unit Leader
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Supply
Unit Leader
Facilities Unit
Leader
Do not use nonstandard titles or hybrid positions.
These titles may be unrecognizable to assisting
or cooperating personnel.
Slide courtesy of FEMA
Command Staff Review
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The Incident Commander may need to
designate staff who can provide
information, liaison, and safety services
for the entire organization
Public Information
Officer
Incident
Incident
Commander
Commander
Liaison
Officer
Command
Staff
Safety
Officer
Public Information Officer, releases information to internal/external stakeholders
Safety Officer, advises the IC regarding incident safety, worker and sites
Liaison Officer, coordinates assisting or contributing agencies
Slide courtesy of FEMA
General Staff-Review
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General Staff in the ICS organizational
structure are appointed as the incident
complexity expands
Incident
Commander
Public Information
Officer
Liaison
Officer
Command
Staff
Safety
Officer
Operations
Section
Planning
Section
Logistics
Section
Finance/Admin
Section
General
Staff
Slide courtesy of FEMA
General Staff Review
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Operations
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Planning
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Prepares and documents the Incident Action Plan
Facilitates the Operations Briefing
Logistics
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Responsible for determining the appropriate tactics for an
incident
Conducts tactical operations, develops the tactical
objectives, and organizes & directs all tactical resources
Presents the Incident Action Plan (IAP)
Provides resources and services required to support
incident activities
Finance
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Responsible for handling claims related to property
damage, injuries, or fatalities
Incident Command System
Span of Control
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Relates to the supervisory structure of the organization
and pertains to the number of individuals or resources
one incident supervisor can effectively manage
1-5 is the recommended ratio
Organizing resources into Sections, Branches, Groups,
Divisions, Units or Teams when the supervisory ratio
will exceed 7 or demobilizing when the supervisory
ratio falls below 3.
Slide courtesy of FEMA
Maintaining Span of Control
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The following supervisory levels can be
added to help manage span of control:
by organizing resources into Divisions,
Groups, Branches or Sections
Divisions
Divide an incident geographically.
Example: east and west wing of a hospital
Groups
Describe functional areas of operation.
Example: decontamination team
Branches
Used when the number of Divisions or Groups
exceeds the span of control. Can be either
geographical or functional.
Include only the functions and positions required to attain the objectives!
Branches that are essential for
maintaining hospital operations
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Medical Care Branch
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Responsible for the provision of medical care of the incident
victims and patients already in the hospital examples
Infrastructure Branch
 Facilitates the acquisition and access to essential
recovery resources
Security Branch
 Responsible for security for facility and staff, liaison
with local agencies
Business Continuity Branch
 Facilitates the acquisition and access to essential
recovery resources
Staging Manager is a new area
for Hospital Incident Command
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Operations Function
Responsible for deploying resources
May have several staging areas
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Medications
Staff (Labor pool)
Transportation
Resources within the Staging Areas are
available and ready for assignment (rest
and repair areas are NOT located at
staging)
ICS Communication System
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Improves communication – internally and externally
Standardizes terminology
Allows accountability
Two Types of communication
 Formal follow lines of authority when
• Receiving and giving work assignments
• Requesting support or additional resources
• Reporting progress on assigned tasks
 Informal communication does not follow lines of
authority
• Is used to exchange incident or event
information only
Allows for documentation on HICS Forms
Chain of Command
(Single, Unity)
Orderly
Line of
Authority
Single
Command
Operations
Section Chief
HAZMAT Branch
Director
Incident
Commander
Public Information
Officer
Liaison
Officer
Safety
Officer
Planning
Section Chief
Medical Care
Branch Director
Command
Staff
Logistics
Section Chief
Service
Branch Director
Finance/Admin
Section Chief
General
Staff
Support
Branch Director
Unity of command
Means that each employee answers to ONE supervisor
Slide courtesy of FEMA
Single versus
Unified Command
Single command
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One organization and
single IC has complete
responsibility for incident
(hospital receives victims
from train crash)
Unified command
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Agency 1
Agency 2
Multiple agencies /
organizations share
responsibility
Collective / collaborative
approach
Single set of objectives
for multiple agencies
Improved information flow
and coordination
Agencies understand joint
priorities and restrictions
Single IAP
Agency 3
Photos courtesy of FEMA
Information and Intelligence
Within ICS
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Establishes a process for gathering, sharing, and
managing incident related information and intelligence
Assures that internal information is safeguarded but also
ensures availability to those who need it to perform their
jobs effectively and safely.
Often handled within Planning, Situation Unit
However, in some situations may require:
 As a branch within Operations
 Within the Command Staff
 As a separate General Staff Section
Briefings/Meetings Features
of ICS
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Essential to ICS for good supervision and
incident management
Short concise meetings, no long
discussions or complex decision making
Allow manager or supervisor to pass along
specific information and expectations for the
upcoming work period
Opportunity to field questions from
subordinates related to that information
Types of Briefings/Meetings
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Staff-Level Briefings: Delivered to
resources assigned to nonoperational and support tasks at the
Incident Command Post or Base.
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Field-Level Briefings: Delivered to
individual resources or crews
assigned to operational tasks and/or
work at or near the incident site.
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Section-Level Briefings: Delivered to
an entire Section (e.g., the
operational period briefing).
Slide courtesy of FEMA
Briefings
 Clearly
stated objectives and
the following elements:
Task
What is to be
done?
Purpose
End State
Why it is to be
done?
How it should
look when
done?
Slide courtesy of FEMA
Operational Period Briefing
(Shift briefing)
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Conducted at the beginning of each
operational period
Facilitated by the Planning Section Chief
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Operations Briefing is held to introduce IAP
to Branch Directors and Division/Group
Supervisors
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After the Operational Briefing, the
Incident Action Plan is implemented
Schedule for Operations
briefing
Planning section chief reviews agenda and facilitates
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IC presents objectives (sometimes defers to Planning Chief to present)
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Off-going Operations Section Chief – provides current assessment and
accomplishments during last ops period
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Oncoming Operations Section Chief – covers work assignments and staffing
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Technical Specialist -Safety Officer – Special Operations –present updates
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May have specific Unit Leaders present information
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Final IC comments
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Planning Section Chief announces next briefing time/location, adjourn
Incident is
recognized
Notifications,
assessment,
Immediate
needs
are
addressed
Incident Manager
Sets overall
incident objectives
& priorities
Management
Meeting
Evaluates
& revises
incident
objectives
Assess progress
using measures
of effectiveness
Planning
Meeting
Develop
strategies &
tactics to
Accomplish
objectives
On-going
situation
assessment
& information
processing
Action Plan
preparation
& approval
Operations
Briefing
Briefs the
operational
leaders on the
Action Plan
Implement
Action Plan
United States Coast Guard
ICS Tools
Emergency Operations Plan
 Hospital Policies and Procedures Manual
 ICS Forms
 Position Description and Job Action
Sheets
 Other resource materials
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Are you Ready?
Are you now able to:
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Explain how the modular organization
expands and contracts?
Given a scenario, recognize complicating
factors?
Use a planning cycle?
Create an incident action plan?
MERET Acknowledges its Partners:
1. Healthcare System Preparedness Program Partners
a. Minnesota Department of Health–Office of Emergency
Preparedness
b. MDH Metropolitan Hospital Compact
c. Regional Hospital Resource Center Focus Group:
• Michelle Allen, Northwest
• Clyde Annala, Northeast
• Jill Burmeister, South Central
• Chuck Hartsfield, Central
• Marla Kendig, Southeast
• Emily Parsons, MDH-OEP
• Justin Taves, West Central
• Eric Weller, South Central
2. FEMA Independent Study Program