Charles Stewart MD EMDM

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The Incident Command System

• Charles Stewart MD EMDM

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ICS Incident Command System
President
Unified Command
FEMA
Incident Command
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An Organized Response

• Requires planning
• Coordinates resources and personnel
• Find a video that shows an organized response

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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

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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.
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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.

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

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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.

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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

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Responder Etiquette
Report to a staging area, not the disaster site
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Accountability Task

• Give clear assignments
• Ensure assignment is understood
• Provide adequate resources
• Task Completion

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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
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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

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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

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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

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Basic Military Command Structure
Commander
CommandSergeant Major
Executive OfficerXO
S4 Supply
S3 Operations
S1 Personnel
S2 Intelligence
S6 Signals
S5 Civil-Military Operations
Surgeon
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Basic ICS Organizational Structure
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Small Scale On-Scene ICS
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Emergency Dept ICS
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Larger Scale Hospital ICS
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Mobilization of Resources
What resources are available to my community
during an MCI?
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Predicting Casualty Flow
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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

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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)

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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.

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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

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The Incident Commander

• Role
• Assumes and announces command
• Leads response effort

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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.

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Assessment and Care of Multiple Patients

• On-Scene
• Rescue/Extrication
• Triage
• Treatment
• Transport

• Hospital
• Decon
• Triage/Re-Triage
• Treatment
• Admission/Discharge/Transfer

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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

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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)

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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?)

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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

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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

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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.

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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

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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

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Staying Organized

• Organizational Tools
• Plans
• Protocols
• Forms
• Job Action Sheets

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Break