NIMS (National Incident Management System) for Healthcare

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NIMS (National Incident Management System) for
Healthcare

• Based upon Emergency Management Institute ICS-700

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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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Hospital Command General Staff
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Objectives

• Identify the key principles of NIMS in the
  context of healthcare.
• Recall when it is appropriate to initiate an Area
  Command.
• Name the functions and purpose of a Multiagency
  Coordination Center.
• Select the appropriate utilization of the Public
  Information Systems within NIMS.
• Compare how NIMS and HICS affect how healthcare
  prepares for incidents and events.
• Recognize the concepts and principles of resource
  management under NIMS HICS.
• Identify the benefits of common communication and
  information management standards.

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What is NIMS?

• a consistent nationwide approach for federal,
  state, tribal, and local governments to work
  effectively and efficiently together to prepare
  for, prevent, respond to and recover from
  domestic incidents, regardless of cause, size or
  complexity.
• - Secretary of Homeland Security directed
  President of USA to develop administer a
  National Incident Management System (NIMS)
• Homeland Security Presidential Directive /
  HSPD-5, 2003

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What is NIMS?

• A comprehensive, national approach to incident
  management
• Applicable at all jurisdictional levels and
  across disciplines

Slide courtesy of FEMA
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NIMS Concepts and Principles

• NIMS is
• Flexible and Standardized to improve overall
  response and interoperability and enable all
  responding organizations to work together.

Slide courtesy of FEMA
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NIMS NRP Relationship
National Incident Management System (NIMS)
Standardized process and procedures for
incident management
NIMS aligns command control, organization
structure, terminology, communication protocols,
resources and resource typing
Incident
DHS integrates and applies Federal resources
Local Support or Response
Resources, knowledge, and abilities from all
Federal agencies
State Support or Response
Federal Support or Response
National Response Plan (NRP) Activation and
proactive application of integrated Federal
resources
NRP is activated forIncidents of National
Significance
http//www.nrt.org/production/NRT/NRTWeb.nsf/AllAt
tachmentsByTitle/A-319CharlieHessNIMS-NRPBrief/Fi
le/Charlie_Hess_NIMS-NRP_Brief.ppt?OpenElement324
,6,NIMS NRP Relationship
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Tiered Response Strategy
Capabilities and Resources
Federal Response
State Response
Regional / Mutual Response Systems
Local Response, Municipal and County
Minimal Low Medium High Catastrophic
Increasing magnitude and severity
'Medical Surge Capacity and Capability Handbook'
by J. Barbera and A. Macintyre published by CNA
Corporation.
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Tiered Response
HCF Health Care Facility
'Medical Surge Capacity and Capability Handbook'
by J. Barbera and A. Macintyre published by CNA
Corporation.
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NIMS Training Deadlines

• 1. August 31, 2007 (ISC-100 HC)
• Emergency Managers (ICS-100 HC, ICS-200 HC,
  ICS-700 and IS-800)
• Command Staff (ICS-100 HC, ICS-200 HC and
  ICS-700)
• PIO
• Liaison Officer
• Incident Commander (only Commander title)
• Safety Officer
• General Staff(ICS-100 HC, ICS-200 HC and ICS-700)
• Section Chiefs (Operations, Planning, Logistics,
  Financethe only reference to Chiefs)
• 2. August 31, 2008 (ISC-100 HC)
• Staff filling boxes below section chiefs

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NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

Slide courtesy of FEMA
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NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

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Command and Management

• Incident Command System (ICS)
• Hospital Incident Command System (HICS)
• You learned this in ICS-100 HC and ICS-200 HC
• Proven management system based on best practices
• Span of control may vary from 3 7
• Use common terminology to reduce confusion
  between ICS position and day-to-day position
• Embraces management-by-objectives in developing
  Incident Action Plans
• Recognizes Multiagency Coordination Entity when
  resources cannot be obtained locally

Slide courtesy of FEMA
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Command and Management

• In some situations, NIMS recommends variations in
  incident command
• Most common variations are
• Unified Command
• Area Command

Slide courtesy of FEMA
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Unified Command

• Used when more than one agency is involved such
  as with a hazardous material spill
• Collective / collaborative approach

ONE Incident Action Plan
Photos courtesy of FEMA
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How Does Unified Command Work?

• Agencies work together to
• Analyze intelligence information
• Establish single set of objectives strategies
  for multiple agencies
• Create single Incident Action Plan (IAP)
• Improved information flow coordination
• Agencies understand joint priorities
  restrictions
• Unified Command does not change other features of
  ICS.

Slide courtesy of FEMA
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How is Area Command Organized?
Slide courtesy of FEMA
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What Does Area Command Do?

• Sets overall strategy and priorities
• Allocates resources
• Ensures proper management
• Ensures objectives are met
• Ensures strategies are followed
• Is particularly relevant to public health
  emergencies because incidents where area command
  are used
• Are not site specific
• Are not immediately identifiable
• Are geographically dispersed and evolve over time
• Area Command does not include an Operations
  Section because operations are conducted
  on-scene.
• May become a Unified Command Area

Slide courtesy of FEMA
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How is Area Command Organized?
Slide courtesy of FEMA
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Command and Management

• Multiagency Coordination Center
• For large or wide-scale emergencies
• Aids in resource allocation decisions based on
  incident priorities
• Emergency Operations Centers may support the need
  for multiagency coordination and Joint
  Information activities
• Handles requests for items that IC cannot obtain
  locally

Slide courtesy of FEMA
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Multiagency Coordination Center (MAC)

• NOT Area Command
• Function scope is incident-driven
• Coordinate incident-related information
• Resource management center for agencies
• Strategic planning
• Surveillance and Epidemiology
• Patient Care
• Population-based Interventions
• Personnel management
• Liaison with jurisdictional agencies and EOCs to
  coordinate issues regarding incident management
  policies, priorities strategies

Slide courtesy of FEMA
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MAC

• Simple and brief in use or complex and protracted
  based on event
• Coordination Center that can also be activated to
  assist Area Command for
• Multiple concurrent health-related incidents
• Incidents that are non-site specific
• Incidents that are geographically dispersed
• Incidents that evolve over time

Slide courtesy of FEMA
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MAC for Health Care

• EMS
• Hospitals
• Public Health
• Emergency Management
• Activation
• Site
• Staffing
• Authority

Slide courtesy of FEMA
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Hospital C
Hospital B
Clinics
Hospital A
Health System
Regional Hospital Resource Center
Multi-Agency Coordination Center EM
EMS PH
A
A
B
B
C
C
A
C
Jurisdiction Emergency Management
B
Public Health Agencies
EMS Agencies
Slide courtesy of John Hicks
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Command and Management

• Public Information coordination across responding
  agencies is important for the public to receive
  accurate, timely, and consistent information that
  is easy to understand
• The Public Information Officer (PIO) is part of
  the command staff
• PIO operates within the parameters of a Joint
  Information System when established as part of a
  Multiagency Coordination or Area Command
• Each agency or organization contributing to the
  Joint Information System retains their
  organizational independence while using the Joint
  Information System protocols

Slide courtesy of FEMA
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NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

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How Does NIMS Define Preparedness?

• Taking actions to establish and sustain
  prescribed levels of capability
• Ensures mission integration and interoperability

Slide courtesy of FEMA
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Comprehensive Emergency Management Cycle

• 4 Phases
• Mitigation prevention or activities that reduce
  impact of hazard
• Preparedness build response capacity/capability
• Response gain control of an event
• Recovery return to pre-disaster state

Slide courtesy of FEMA
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Community- Based Hazard Vulnerability Analysis
(HVA)
(images courtesy of USA.gov)
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MDH Regions
Slide courtesy of John Hicks
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Preparedness

• Mutual Aid Agreements and Emergency Management
  Assistance Compacts
• facilitate timely delivery of assistance

Slide courtesy of FEMA
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Preparedness

• Metropolitan Hospital Compact
• Since April 9, 2002
• 27 hospitals operating 4800 beds
• 7 counties participate
• Agreement provides for
• Staff and supply sharing
• Staffing off-site facilities for first 48h
• Communications, JPIC
• Regional Hospital Resource Center (HCMC)

Slide courtesy of John Hicks
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NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

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Resource Management

• Resource management is an important concept for
  preparedness organizations at all levels and
  helps to
• Establish guidelines and protocols for resource
  management
• Establish procedures to track resources from
  mobilization through demobilization
• Categorize resources (resource typing) based on
  measurable standards of capability and performance

Slide courtesy of FEMA
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Resource Management

• Regional Hospital Resource Center (RHRC)
• Designated hospital in a geographic or functional
  region that is the coordinating hospital for
  information and requests
• Acts as broker for patient transfers into / out
  of the region
• May help make allocation decisions for resources
  (eg staffing)
• Represents hospital needs and issues to
  Multi-Agency Coordination Center

Slide courtesy of John Hicks
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Capacity vs. Capability

• Surge Capacity the ability to manage increased
  patient care volume that otherwise would severely
  challenge or exceed the existing medical
  infrastructure
• Surge Capability the ability to manage
  patients requiring unusual or very specialized
  medical evaluation and intervention, often for
  uncommon medical conditions
• Barbera and Macintyre

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Surge Capacity/Patient Care Coordination
MAC
From the Minnesota Department of Health, Pat
Tommet
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NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

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Communications Information Management through
the Joint Information System (JIS) Protocols

• To ensure consistency among all who respond, all
  responding agencies must have a common operating
  picture
• PIOs operate within the parameters of a JIS
• Keys to a common operating picture
• Interoperable communications across all agencies
  and jurisdictions
• Information systems based on common architecture

Slide courtesy of FEMA
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Joint Information Center (JIC)

• Physical location where public information staff
  collocate/organize factual information
• Provides the structure for coordinating and
  disseminating official/critical information

Slide courtesy of FEMA
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JIC
Slide courtesy of FEMA
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JIC Characteristics

• Includes representatives of all players in the
  response both private and public organizations
• Has procedures and protocols for communicating
  and coordinating with other JICs
• May be established at various levels of
  government
• In case of Unified Commandagencies
  contributing retain their organizational
  independence
• When multiple JICs are established, each JIC
  contributes to the overall unified message using
  joint information system protocols

Slide courtesy of FEMA
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JIC Components
Slide courtesy of FEMA
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NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

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Supporting Technologies

• 800MHz radios
• HAM radios
• Mission Mode
• MN-TRAC
• HAN (Health Alert Network)-

Slide courtesy of FEMA
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NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

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Ongoing Management and Maintenance

• NIMS Integration Center
• Maintains and manages national-level preparedness
  standards
• Facilitates definition of general training
  requirements and approved courses
• Reviews and approves equipment lists meeting
  national standards
• Defines minimum levels of training, experience,
  fitness, capability and currency by establishing
  certification and credentialing standards for key
  personnel
• Develops Corrective Action Plan based on lessons
  learned from actual incidents

Slide courtesy of FEMA
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Group efforts

• Information sharing (ARC, MAC, CST)
• Communications (web-based future system, 800Mhz,
  amateur radio)
• Education (bio, chemical, radiation)
• Personal Protective Equipment
• HRSA grant requirements
• Infectious disease protocols / response
• Workforce issues
• Pharmaceutical cache storage and release
• Drills

Slide courtesy of John Hicks
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Federal Assets

• National Disaster Medical System (NDMS)
• Urban Search and Rescue (eg Nebraska TF-1)
• Commissioned Corps Readiness Force
• Military (NORTHCOM)
• Federal Medical Stations
• CDC SNS and VMI

Slide courtesy of John Hicks
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NDMS

• Disaster Medical Assistance Teams
• Specialty teams (DMORT, VMAT, Burn, etc)
• Patient movement
• Public / private partnership
• Voluntary commitment of civilian hospital beds
  for defense or disaster use accept casualties
  from affected area
• Response, evacuation, and definitive care
• 2000 hospitals, 65 FCCs

Slide courtesy of John Hicks
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NDMS Patient Movement

• During crisis, system placed on alert
• Bed counts submitted to FCC / GPMRC
• Patient needs matched to beds available
• Patients arrive by military airlift
• Distributed to area hospitals
• Never fully activated until Hurricane Katrina
• More mass evacuation than transfers

Slide courtesy of John Hicks
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Summary NIMS Components

• Command and Management
• Preparedness
• Resource Management
• Communications and Information Management
• Supporting Technologies
• Ongoing Management and Maintenance

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Are You Ready for the Test?
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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