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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 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 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) 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 Recovery Gain control of an event Examples: plug dike when a hole appears, Emergency shelter, housing, food & water Search and rescue Evacuation Emergency medical services 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 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) 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) 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 Establish the general plan or direction for accomplishing the incident objectives (IC) 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 Operational periods set by IC usual breakdown Immediate 0-2 hours Intermediate 2-12 Extended over 12 hours Initiate planning cycle Extended Response Phase 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 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 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 An Incident Commander's scope of authority is derived: 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 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 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 More qualified person / team arrives End of operational period / extended incident handoff Always includes transfer of command briefing • Current situation • Response needs • Available resources All personnel will be informed of the effective time and date of the transfer of command Modular Organization The modular/flexible organization structure of the ICS allows standardization of positions and number of positions depending on the extent of the incident ICS organizational structure should include only the functions and positions needed to achieve the incident objectives ICS positions may not be combined in order to save on staffing or achieve a higher level of efficiency 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 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 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 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 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 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 Operations Planning Prepares and documents the Incident Action Plan Facilitates the Operations Briefing Logistics 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 Responsible for handling claims related to property damage, injuries, or fatalities Incident Command System Span of Control 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 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 Medical Care Branch 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 Operations Function Responsible for deploying resources May have several staging areas 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 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 One organization and single IC has complete responsibility for incident (hospital receives victims from train crash) Unified command 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 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 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 Staff-Level Briefings: Delivered to resources assigned to nonoperational and support tasks at the Incident Command Post or Base. Field-Level Briefings: Delivered to individual resources or crews assigned to operational tasks and/or work at or near the incident site. 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) Conducted at the beginning of each operational period Facilitated by the Planning Section Chief Operations Briefing is held to introduce IAP to Branch Directors and Division/Group Supervisors After the Operational Briefing, the Incident Action Plan is implemented Schedule for Operations briefing Planning section chief reviews agenda and facilitates ▼ IC presents objectives (sometimes defers to Planning Chief to present) ▼ Off-going Operations Section Chief – provides current assessment and accomplishments during last ops period ▼ Oncoming Operations Section Chief – covers work assignments and staffing ▼ Technical Specialist -Safety Officer – Special Operations –present updates ▼ May have specific Unit Leaders present information ▼ Final IC comments ▼ 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 Are you Ready? Are you now able to: 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