National Incident Management System Incident Command System

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National Incident Management SystemIncident
Command System

• Craig R. Savageau, M.S. HCMG, EMT-P
• Educator
• Office of Disaster Preparedness
• Saint Barnabas Health Care System

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WHY NIMS?

• Presidential Decision Directive -5
• Preparedness funding tied to compliance
• Executive Order 50
• JCAHO Environment of Care
• E.C. 1.4 e. Definition of a common (that is,
  "all-hazards") command structure within the
  organization for responding to and recovery from
  emergencies, that links with the command
  structure in the community.
• It works!

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What about HEICS?

• Hospital Emergency Incident Command System
• A version of ICS/IMS developed for hospitals
• Not specifically NIMS compliance
• HEICS and ICS have minor differences, defeating
  the intent of NIMS
• Concepts of HEICS can still be used while
  maintaining NIMS compliance
• Job Action Sheets

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History of ICS

• Developed in the 1970s as a result of devastating
  wildfires in California
• Needed a system to work toward common goals in
  efficient and effective manner
• Organizational charts and other techniques taken
  from business management principles

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The Incident Command System

• IS a system to provide management during
  emergencies
• IS NOT an emergency operations plan
• DOES assist in developing an incident specific
  management structure
• DOES NOT replace existing hospital management
  structures

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Without an Incident Management System

• CHAOS would result!

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Incident Command System

• Can be used for any size emergency large or
  small
• Uses common terminology and operating procedures
• Timely combining of resources during an emergency
• System for controlling personnel, equipment,
  facilities, and communication

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UNDERSTANDING ICS

• KEY ELEMENTS
• Common Terminology
• Modular Organization
• Management by Objectives
• Incident Action Plans
• Manageable Span of Control
• Predestinated Incident Facilities
• Resource Management
• Integrated Communications
• Establishment and Transfer of Command
• Unity of command and Chain of Command
• Unified Command
• Accountability
• Deployment
• Information or Intelligence Management
• Flexibility

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Emergency Operations Center

• The center formerly know as the
• Command Center
• Emergency Operations Center is the correct NIMS
  terminology

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Emergency Operating Centers (EOC)

• The EOC is a pre-designated facility established
  by an agency to coordinate the overall response
  and support to an emergency.

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EOC Mission

• Communication and Intelligence
• Strategic Direction
• Coordination and Documentation

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When do we activate the EOC?
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Predesignated Incident Facilities

• Established by the Incident Commander based on
  the requirements and complexity of the incident.
  

Base
Incident Command Post
Base
Staging Area
Camp
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Command Post

• Dedicated central location
• Isolated from noise and other distractions
• Status board and other visual aids
• Let people know where it is and how to contact
  the CP

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Staging Area

• An area where resources are kept awaiting
  assignment
• May be pre-designated
• May be multiple staging areas per incident

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Incident Facilities Base

• Base
• Is the location from which primary logistics and
  administrative functions are coordinated and
  administered. There is only one Base per
  incident, and it is designated by the incident
  name.
• May be collocated with the Incident Command Post.
  
• Is established and managed by the Logistics
  Section. The resources in the Base are always
  out of service.

B
Symbol
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Incident Facilities Camps

• Camps
• Are where resources may be kept to support
  incident operations if a Base is not accessible
  to all resources. Multiple Camps may be used,
  but not all incidents will have Camps.
• Are temporary locations within the general
  incident area that are equipped and staffed to
  provide food, water, sleeping areas, and sanitary
  services.
• Are designated by geographic location or number.
  

C
Symbol
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Tactical Resources Classifications

• Currently working on an assignment under the
  direction of a supervisor

Assigned

• Ready for immediate assignment and has been
  issued all required equipment

Available

• Not available or ready to be assigned (e.g.,
  maintenance issues, rest periods)

Out-of- Service
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Other Incident Facilities

• HELISTOP
• HELIBASE

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UNDERSTANDING ICS

• Common terminology
• ICS uses standardized titles for positions,
  organizational levels, and facilities
• Allows for easier communication and organization
  between agencies

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UNDERSTANDING ICS

• Modular Organization
• Only the parts of the organization chart that are
  needed for the incident are activated
• Positions can stand up, and stand down as needed
• ICS is designed to expand or contract to fit the
  needs of the incident
• Levels can be added or deactivated depending on
  the size, scope, and/or nature of the incident

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UNDERSTANDING ICS

• Span of control
• Difficult and inefficient for one person to
  manage too many or too few people
• In order to maintain span of control, one person
  should only manage between 3-7 people/units
  (ideally 5)
• Less than 3 people/units consider dissolving
  the supervisory position
• More than 7 people/units an additional level of
  management should be added

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UNDERSTANDING ICS

• Unity of command
• Each unit or person within ICS should answer to
  ONE person
• Multiple superiors can lead to an inability to
  handle assigned tasks, or leave objectives
  unattained
• Staff accountability
• More effective flow of communication

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UNDERSTANDING ICS

• Unified Command concept
• Senior-level SMEs from different
  agencies/departments make joint decisions on
  strategic objectives
• Each discipline has a say in the
  decision-making process
• Communication and directives flow outward from
  unified command to various branches in the table
  of organization

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UNDERSTANDING ICS

• Unified Command Continued
• Sharing of information, resources, and
  responsibility to ensure the smooth and efficient
  delivery of services
• One person (the incident commander) is in
  charge and sets the direction and focus of the
  group

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Reliance on an Incident Action Plan

• Every incident must have an Incident Action Plan
  (IAP) that
• Specifies the incident objectives.
• States the activities to be completed.
• Covers a specified timeframe, called an
  operational period.
• May be oral or writtenexcept for hazardous
  materials incidents, which require a written IAP.

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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?

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Primary ICS Functions
Command Staff
General Staff
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POSITIONS WITHIN ICS

• Incident Commander (IC)
• Overall responsibility for the incident
• Every incident MUST have an Incident Commander
• First person on scene of an incident should
  establish a command
• May be replaced by a more qualified person as
  additional units arrive (Delegation of Authority)

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POSITIONS WITHIN ICS

• Responsibilities of the Incident Commander
• Establish scene safety
• Request additional resources (if necessary)
• Establish a staging area
• Establish an Incident Command Post
• Set incident objectives and priorities
• Appoint personnel to function in other ICS
  positions

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POSITIONS WITHIN ICS

• Operations Section Chief
• Work with the IC to ensure completion of goals
• Develop tactical objectives
• Manage units and resources to accomplish the
  objectives of the incident
• Oversees ICS elements tasked with operations
  dedicated to resolving and mitigating the incident

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Levels of Organization

• There can be additional levels of organization
  used under this (or any) section, known as
• Branches
• Divisions
• Groups
• Task Force/Strike Team
• Single Resources

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POSITIONS WITHIN ICS

• Branches
• Used to manage assets to help maintain span of
  control, and are an intermediate management level
  between the Operations Section and lower levels
• Can separate units by function, geography, or any
  other reason to maintain the span of control
• Common examples are EMS Branch, Fire Branch, and
  Law Enforcement Branch
• Are lead by Branch Directors
• There may be one deputy for each Branch Director

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POSITIONS WITHIN ICS

• Divisions
• Established to divide an area geographically
• Named to describe the geographic area related to
  the incident operations
• Lead by a supervisor
• Not expected to need an assistant

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POSITIONS WITHIN ICS

• Groups
• Established to manage a functional area of
  operations within a branch or a section
• Designed according to a specific task they are
  meant to carry out
• Lead by a supervisor
• Not expected to need an assistant

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POSITIONS WITHIN ICS

• Single Resource
• A lone resource, self lead

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POSITIONS WITHIN ICS

• Task Force
• A collection of different resources tasked with a
  specific mission

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POSITIONS WITHIN ICS

• Strike Team
• A collection of like resources that may be tasked
  with any mission

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POSITIONS WITHIN ICS

• Planning Section
• Responsible for developing short- and long-term
  plans
• Collects, evaluates, and displays information
  about the incident
• Maintains status of equipment and personnel
• Maintains incident documentation
• Led by Planning Section Chief

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POSITIONS WITHIN ICS

• Planning Section
• May be broken down into the following units
• Resources Unit
• Situation Unit
• Documentation Unit
• Demobilization Unit
• Technical Specialists

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POSITIONS WITHIN ICS

• Planning Section
• Each unit is lead by a Unit Leader
• May have a unit manager assigned to the Leader
• Not all incidents will require the activation of
  a Planning Section, or all of the different units
  - in these cases the responsibilities of the
  section revert to the IC
• When there is a Planning Section, but not all of
  the units are established, those responsibilities
  fall back on the Planning Section Chief

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POSITIONS WITHIN ICS

• Logistics Section
• Responsible for all support and services needed
  at an incident
• - Personnel
• - Facilities
• - Equipment
• - Supplies

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POSITIONS WITHIN ICS

• Logistics Section
• This section will be established by the Incident
  Commander, depending on the needs of the incident
• May be broken down into two functional Branches
• Service Branch
• Support Branch
• Each of these branches is overseen by a Branch
  Director
• Each branch can contain three functional units
  not all of these units may be required at a
  specific incident

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POSITIONS WITHIN ICS

• Support Branch
• Supply Unit
• Facilities Unit
• Ground Support Unit

• Service Branch
• Communications Unit
• Medical Unit
• Food Unit

• Each unit is lead by a Unit Leader, who may be
  assisted by a Unit Manager
• If the Logistics Section is not established, the
  responsibilities of that section falls back on
  the Incident Commander
• If the Logistics Section is established, but the
  two branches are not, the responsibility of each
  branch falls back on the Logistics Section Chief

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POSITIONS WITHIN ICS

• Finance Section Chief
• Oversees the Finance/ Administration section
• Usually only utilized at large scale events
• Responsible for tracking and recording costs and
  personnel time

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POSITIONS WITHIN ICS

• Finance
• There can be four units established within this
  section
• Time Unit
• Cost Unit
• Procurement Unit
• Compensation Unit
• These units are established based on the
  particular needs of the incident, as deemed by
  the Incident Commander

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Common Responsibilities
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Mobilization

• Only mobilize to an incident when requested or
  when dispatched by an appropriate authority.
• Make sure that you receive a complete deployment
  briefing.

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Deployment Briefing

• Descriptive location and response area
• Incident check-in location
• Specific assignment (e.g., position, team
  designation, etc.)
• Reporting time

• Communications instructions (e.g., incident
  frequencies)
• Special support requirements (e.g., facilities,
  equipment transportation and off-loading, etc.)
• Travel arrangements (if needed)

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Check-In at the Incident

• The check-in process helps to
• Ensure personnel accountability.
• Track resources.
• Prepare personnel for assignments and
  reassignments.
• Locate personnel in case of an emergency.
• Establish personnel time records and payroll
  documentation.
• Plan for releasing personnel.
• Organize the demobilization process.

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Check-In at the Incident Procedures

• Check in only once at an authorized location
• At the Incident Command Post
• At the Base or Camp(s)
• At the Staging Areas
• At the helibase
• With the Division/Group Supervisor

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Initial Incident Briefing

• Make sure that you receive an initial incident
  briefing.

• Current situation assessment and objectives
• Specific job responsibilities
• Location of work area

• Procedural instructions for obtaining additional
  resources
• Safety hazards and required safety
  procedures/Personal Protective Equipment (PPE),
  as appropriate

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Keep Accurate Incident Records

• Print or type all entries.
• Enter dates in month/day/year format.
• Use military 24-hour time. Use local time.
• Enter date and time on all forms and records.
• Fill in all blanks. Use N/A as appropriate.
• Section Chiefs and above assign a recordkeeper
  (scribe).

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Be Accountable for Your Actions

• Maintain chain of command and unity of command.
  Take direction from a single supervisor.
• Communicate potential hazards and changing
  conditions using clear text and Plain English.
• Act professionally and avoid/report prohibited
  activities such as
• Sexual harassment or discrimination.
• Use of illegal drugs or alcohol.

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When Demobilizing (1 of 2)

• Complete all work assignments and required
  forms/reports.
• Brief replacements, subordinates, and supervisor.
  
• Evaluate the performance of subordinates.
• Follow incident and agency check-out procedures.
• Provide followup contactinformation.

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When Demobilizing (2 of 2)

• Return any incident-issued equipment or other
  nonexpendable supplies.
• Complete post-incident reports, critiques,
  evaluations, and medical followup.
• Complete any administration issues.
• Upon arrival at home, notify the home unit (i.e.,
  whoever is tracking you) of your arrival and
  ensure your readiness for your next assignment.

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The Big Picture
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Lets Organize!

• A major sewage leak has occurred in a Med/Surg
  Unit.
• The unit is full of patients
• The following goals must be achieved
• Evacuate the patients
• Stop the leak
• Clean up the mess

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Lets Organize

• Organize the initial response
• You have the following personnel
• 8 RNs
• 4 LPN/Nursing Assistants
• 1 Nurse Manager
• 1 Vice President of Operations
• 1 Engineering Manager
• 4 Maintenance Staff
• 3 Housekeeping Staff

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Lets Organize!

• Implement the following portions of ICS
• Incident Commander
• Operations Section
• Branches
• Groups or Divisions
• What other portions of ICS could be implemented?

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Bonus Problem

• A small fire has broken out in a patient room
• The patient self evacuated the room
• Staff was unable to attack the fire, but did shut
  the door.
• Minor smoke is on the floor affecting some of the
  patients

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Bonus Problem

• Who is in charge of this incident
• initially?
• next?
• long term?
• Set up an ICS structure to accomplish the
  following goals
• Evacuate the floor
• Extinguish the fire
• Triage/ care for patients over come by smoke
• (outside of the ED)

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Questions?
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For More Information

• Ryan S. McCormick, BS, NREMT-P
• Operations Manager
• Office of Disaster Preparedness
• rmccormick_at_sbhcs.com
• 973 322-4366
• NIMS/ ICS Training
• www.fema.gov/nims