Incident Management for Healthcare Operations

1
Incident Management for Healthcare Operations

• Based upon Emergency Management Institute
  ICS-200HC

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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
Minnesotas 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 OBoyle, 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.
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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.

4

• Imagine the role you will play in your facility
  during this presentation

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Scenario

• 30 minutes ago, a tornado warning was issued for
  a projected touchdown in this community
• It is now 608 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

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How you would respond?

• ? Too busy - its 608 am and a shift change
  will happen in 60 minutes. Day shift can deal
  with this.
• ? Panic - realize that you dont know anything
  about the hospitals 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

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Incidents Require you to ..
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4 Phases of Comprehensive Incident Management
(CEM) Activities for all hazard planning
Notification
Response
Preparedness
Recovery
Mitigation (Prevention)
Examples

• Recovery
• Return to pre-disaster state
• Examples Repair/replacement of dike, damaged
  public facilities (bridges, schools, hospitals)
• Debris cleanup removal
• Temporary housing

• Preparedness
• Build response capacity/capability
• Example buy dike plugs

• Mitigation
• (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

• Response
• Gain control of an event
• Examples plug dike when a hole appears,
• Emergency shelter, housing, food water
• Search and rescue
• Evacuation
• Emergency medical services

NIMS slide adaptation
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Incident progression
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
BOOM!
Slide courtesy of John Hick Hennepin County
Medical Center
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Getting Organized
Nature
Day of the Week
What ? Where ? When ? Whos Involved ? Where Is
It Going ?
Size
Initially
Location
Time of Day
Mobilization Checklist

• INCIDENT BRIEFING
• Date/time of start of incident
• Type of incident
• Services involved
• Current incident status
• Current resource status
• Current strategy/objectives
• Communications systems being used
• Special problems/issues

Command Post Incident Action Planning
Slide courtesy of VA Emergency Management
Training Curricula
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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 organizations reputation

Photos courtesy of FEMA
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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

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IMS FeatureIncident 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

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IAP Establishes Objectives, Strategies, and
Tactics

• State what will be accomplished (agency exec and
  IC)

Incident Objectives

• Establish the general plan or direction for
  accomplishing the incident objectives (IC)

Strategies
Tactics

• Specify how the strategies will be executed.
  (Operations)

Slide courtesy of FEMA
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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 durationgt8-12 hour)
• Determined by
• Situation assessment
• Incident action planning
• Resource management

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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
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) 8. Name of the
individual who prepared the document 9.
Facility Name
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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
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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

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Incident Commander

• The Incident Commander performs all major ICS
  command and staff responsibilities unless
  delegated and assigned.

Public Information Officer
Incident Commander
Liaison Officer
Incident Commander
Safety Officer
Operations Section Chief
Planning Section Chief
Logistics Section Chief
Finance/Admin Section Chief
Slide courtesy of FEMA
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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

Photos courtesy of FEMA
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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

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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

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Transfer of Command-Review

• 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

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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
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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
Situation Unit
Operations Section
RescueGroup
Medical Group
Slide courtesy of FEMA
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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
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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
Liaison Officer
Incident Commander
Incident Commander
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
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General Staff-Review

• General Staff in the ICS organizational structure
  are appointed as the incident complexity expands

Incident Commander
Public Information Officer
Command Staff
Liaison Officer
Safety Officer
General Staff
Operations Section
Planning Section
Logistics Section
Finance/Admin Section
Slide courtesy of FEMA
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General Staff Review

• Operations
• 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)
• Planning
• Prepares and documents the Incident Action Plan
• Facilitates the Operations Briefing
• Logistics
• Provides resources and services required to
  support incident activities
• Finance
• Responsible for handling claims related to
  property damage, injuries, or fatalities

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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
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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

Divide an incident geographically. Example east
and west wing of a hospital
Divisions
Describe functional areas of operation. Example
decontamination team
Groups
Used when the number of Divisions or Groups
exceeds the span of control. Can be either
geographical or functional.
Branches
Include only the functions and positions required
to attain the objectives!
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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

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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)

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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

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Chain of Command (Single,
Unity)
Incident Commander
Orderly Line of Authority Single Command
Public Information Officer
Command Staff
Liaison Officer
Safety Officer
General Staff
Operations Section Chief
Planning Section Chief
Logistics Section Chief
Finance/Admin Section Chief
HAZMAT Branch Director
Medical Care Branch Director
Service Branch Director
Support Branch Director
Unity of command Means that each employee
answers to ONE supervisor
Slide courtesy of FEMA
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Single versusUnified Command

• Single command
• One organization and single IC has complete
  responsibility for incident (hospital receives
  victims from train crash)

• Unified command
• 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

Photos courtesy of FEMA
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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

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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

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Types of Briefings/Meetings

• Staff-Level Briefings Delivered to resources
  assigned to non-operational 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
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Briefings

• Clearly stated objectives and the following
  elements

Task
What is to be done?
Slide courtesy of FEMA
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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

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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

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Planning Meeting Develop strategies tactics
to Accomplish objectives
Incident is recognized Notifications, assessment,
Immediate needs are addressed
Incident Manager Sets overall incident
objectives priorities
Action Plan preparation approval
Management Meeting Evaluates revises incident ob
jectives
On-going situation assessment
information processing
Operations Briefing Briefs the operational leaders
on the Action Plan
Assess progress using measures of effectiveness
Implement Action Plan
United States Coast Guard
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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
• Explain how the modular organization expands and
  contracts?
• Given a scenario, recognize complicating factors?
• Use a planning cycle?
• Create an incident action plan?

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MERET Acknowledges its Partners

• 1. Healthcare System Preparedness Program
  Partners
• a. Minnesota Department of HealthOffice 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