Leadership Tools In A Mass Casualty Incident

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Leadership Tools In A Mass Casualty Incident

• Wednesday, April 20, 2005
• 100 PM - 200PM

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Tools for Hospital Leadership

• National Response Plan
• National Incident Management System
• Incident Command System
• Exercises
• Your Hospital Emergency Management Plan

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Tools for Hospital Leadership

• National Response Plan

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You and Your Hospital Play a Key Role in the
National Response Plan

• The NRP coordinates the efforts of all responders
  so that the response is consistent and integrated

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National Response Plan

• Comprehensive, national, all-hazards approach to
  domestic incident management
• Based on NIMS (more to follow)
• Provides the structure and mechanisms for
  national level policy making and coordination of
  federal resources to state and local incident
  managers

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National Response Plan

• Does not alter or impede ability of any agency in
  its response
• Assumes that incidents are managed at the lowest
  possible level
• Activated for incidents of national significance

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Incidents of National Significance

• High -impact incidents that require coordination
  by the Department of Homeland Security
• Versus majority of incidents, handled by
  responsible jurisdictions

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15 Emergency Support Functions

• The role and responsibility of hospitals fall
  under ESF 8, Public Health and Medical Services

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Your Hospital Is An Essential Component of the
National Response

• How Is Your Hospital Response Coordinated With
  Others?

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Tools for Hospital Leadership

• National Incident Management System (NIMS)

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NIMS

• National Incident Management System
• a consistent approach to incident management to
  enable various jurisdictions and agencies to work
  together to prepare for, prevent, respond to and
  recover from incidents
• Homeland Security Presidential Directive 5 (HSPD
  5) defines hospitals as first responders

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Benefits of NIMS

• a balance of flexibility and standardization
• common doctrine, terminology, concepts,
  principles and execution
• so that execution in response to an incident will
  be seamless and consistent
• so that focus is on response rather than on
  organization

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5 Components of NIMS

• 1. Incident Command System
• standardized incident management organization
• 2. Preparedness
• mitigation, planning, response, recovery
• 3. Resource Management
• personnel, equipment and supplies

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5 Components of NIMS

• 4. Communications
• interoperability
• 5. Joint Information System
• timely, accurate and unified public messages

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NIMS Compliance

• Adoption of NIMS is a condition for receiving
  federal preparedness assistance grants and
  contracts
• Hospitals must be NIMS compliant by the beginning
  of FY 2006 (October 1, 2005)
• NIMS compliance adoption of ICS by your hospital

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NIMS Compliance

• The Hospital Disaster Preparedness Program is
  assisting all hospitals to be in compliance with
  these 5 NIMS components
• You will be in compliance with NIMS through these
  efforts and the adoption of ICS by your hospital

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Tool for Hospital Leadership andNIMS Component 1

• Incident Command System

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Why the Need for ICS?

• Problem confusion about who is in charge of what
  and when, together with unclear lines of
  authority, have been the greatest contributors to
  poor response
• Benefitallow personnel from a variety of
  agencies to meld rapidly into a common management
  structure

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Hospitals Are Ready for ICS

• Hospitals are very well-prepared for ICS
• Present, day-to-day organizational structure is
  very similar to ICS in principle and concept
• Only change may be use of titles for the ICS
  positions, use of clear text (no jargon) and
  ICS span of control recommendations

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Adoption of Top 8 ICS Positions

• Incident Commander
• Security/Safety
• Public Information Officer
• Liaison
• Operations Section Chief
• Logistics section Chief
• Planing Section Chief
• Finance Section Chief

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ICS Implications

• Hospitals are encouraged to follow ICS structure
  below the 8 top positions
• Hospitals are encouraged to have Job Action
  Sheets (Just-In-Time training) for all your
  staff, involved in an incident response

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Job Action Sheets

• Benefits
• concise mission statement
• just-in-time training
• prioritization of responsibilities
• defined reporting relationships
• supporting documentation necessary for
• financial recovery/reduction of liability
• Job Action Sheets www.heics.com

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Identification of ICS Leaders

• Persons, who will fill these roles, and their
  back-ups need to be identified prior to an
  incident
• These persons need training on how to work
  together in the Incident Command Center
• These persons need to know their counterparts in
  your local community
• Your EM Committee can assist you in this area

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Advice from the Troops

• Support your Emergency Management Committee in
  its need to perform exercises of your plan
• Support the recommendations of those in the
  trenches, especially with physician related
  issues
• Emergency Preparedness needs financial
  support/budget

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Advice from the Troops

• Your hospital has a plan. Know it, exercise it
  and use it.
• Consult with EM Committee as to who will best
  serve as the Incident Commander
• Note Senior management may serve as a resource
  to the Planning Section Chief

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Advice from the Troops

• Job Action Sheets work well for specific
  functions, but not as well for strategic, policy
  and operational decisions at the highest level.
• Senior management needs to exercise ICS
• Senior management needs to exercise the issues
  that will arise in Day 2 and after

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Advice from the Troops

• Not every decision needs to go through the
  Incident Commander (key ICS principle)
• decisions are made and implemented at the
  appropriate level
• your support of ICS helps your staff to know they
  have the authority to make these decisions
• exercise, exercise, exercise so that you and your
  staff are not surprised

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ICS Training

• More complete information to follow
• 1000 subsidy for
• ICS expert (e.g. EM Committee Chair)
• 15 minutes training for staff
• 1 hour training for hospital leadership
• ICS Table-Top Exercise (optional and no cost)

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NIMS Component 2

• Planning

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Planning

• The critical plan is your hospital Emergency
  Management Plan
• Wisconsin Hospital Emergency Preparedness Plan
  (WHEPP) are guidelines for adapting your plan for
  mass casualty incidents
• Measures are CAPACITY and CAPABILITY Indicators

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NIMS Component 3

• Resource Management

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Personnel Qualification

• Hospitals have established protocols for
  qualifying staff for specific responsibilities
  in a disaster
• Resources for personnel qualification in a
  disaster
• WEAVR (Wisconsin Emergency Assistance Volunteer
  Registry)
• WDC (Wisconsin Disaster Credentialing)

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Equipment Certification

• Hospitals have MOUs for sharing of equipment and
  supplies
• Resources for equipment/supplies in a disaster
  (e,g. Personal Protective Equipment
  Inventory,Decontamination Equipment Inventory,
  Interim Pharmaceutical Stockpile, ChemPacks,
  Surge Beds)

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NIMS Component 4

• Communications

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State Expert Panel on Communications

• 4 levels of redundancy
• landlines
• UHF/VHF Radio interoperability
• satellite telephone
• HAM radio
• Funding available, beginning 9/1/2005

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NIMS Component 5

• Joint Information System

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Public Information

• Need consistent messages
• Risk Communications to be provided by federal and
  state government just-in-time
• downloadable through the Wisconsin Health Alert
  Network (HAN)
• Joint Information Center
• tool for keeping our messages consistent

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Tool for Hospital Leadership

• Exercises

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Training

• Much of the training is Just-In-Time
• Diagnosis and Treatment information
• Job Action Sheets
• HRSA Subsidized Training for hospitals
• Decontamination
• Incident Command
• Further training resources are planned

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Exercises

• JCAHO has standards for two annual exercises
• one functional exercise
• one functional exercise, involving community
  partners
• Capability Indicators are measured only through
  exercise, e.g. lockdown and traffic control
  protocols

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Tool for Hospital Leadership

• Your Hospital
• Emergency Management Plan

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Next Month May 17, 2005

• Next month we will discuss how an incident will
  unfold and what response is expected of your
  hospital
• Minimum Level of Readiness Indicators document
  how ready is your hospital is

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Comments and Questions
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Contact Information

• Bill Bazan
• VP Metro Milwaukee
• Wisconsin Hospital Association
• 414-431-0105 bbazan_at_mailbag.com

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Contact Information

• Dennis J. Tomczyk
• Director, Hospital Bioterrorism Preparedness
• Wisconsin Division of Public Health
• 608-266-3128 tomczdj_at_dhfs.state.wi.us