Module 2: ICS

1
Module 2 ICS
President
Unified Command
FEMA
Incident Command
2
An Organized Response

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

3
Key Principles of NIMS ICS

• Span of Control
• Unity of Command
• Accountability

4
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.
5
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.

6
What is Unity of Command?
Unity of Command means that you answer to only
one person for tasks and assignments.
7
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?

8
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.

9
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

10
Responder Etiquette
Report to a staging area, not the disaster site
11
Accountability Task

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

12
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 else where do
  so

Medical volunteers at staging area
13
Break
14
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

15
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

16
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

17
Basic ICS Organizational Structure
18
Small Scale On-Scene ICS
19
Emergency Dept ICS
20
Larger Scale Hospital ICS
21
Mobilization of Resources
What resources are available to my community
during an MCI?
22
Predicting Casualty Flow
23
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

24
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)

25
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

28
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.

29
Assessment and Care of Multiple Patients

• On-Scene
• Rescue/Extrication
• Triage
• Treatment
• Transport
• see slide 40

• Hospital
• Decon
• Triage/Re-Triage
• Treatment
• Admission/Discharge/Transfer
• see slide 41

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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)

32
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?)

33
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

34
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

35
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.

36
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

37
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

38
Staying Organized

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

39
Group Activity

• Working with your group take ten minutes to
  prepare a VERBAL Incident Action Plan (IAP) for
  the first 15 minutes of the incident.
• Describe the situation, what you are going to do
  about it, and who is going to help you do it.
• Select a spokesperson and be prepared to
  verbalize the IAP

40
Break