H E I C S-

Presented by:Jersey City Medical Center

Emergency Medical Services

HospitalEmergencyIncidentCommandSystem

H E I C S- Establishing the Need

“As part of America's vital health care infrastructure, hospitals play a key role in disaster readiness throughout our country.”

Source: American Hospital Association Website

H E I C S- Establishing the Need

A New York hospital responded to the first outbreak of West Nile Virus back in 1999.

There was the potential for a large number of actual patients, and many people who had “perceived” symptoms.

H E I C S- Establishing the Need

The components of a hospital network’s emergency preparedness plan were put in place when the first of a series of devastating hurricanes threatened the coast of North Carolina in 1996.

H E I C S- Establishing the Need

A Virginia hospital treated victims from the Pentagon on September 11 and postal workers that contracted Anthrax in October 2001.

H E I C S-H E I C S- Current State of Preparedness

A recent study concluded that of the 30 hospitals in FEMA Region III (WV, PA, MD,

VA and DC)…

0% able to handle a biologic event

17% able to handle a chemical event

17% able to handle a radiologic event

Source: Treat, K. , et al. (2001) . Hospital Preparedness for weapons of mass destruction incidents (Annals of Emergency Medicine)

H E I C S- Current State of Preparedness

The same report also concluded that…

73% had only ONE room for decontamination

27% incorporated WMD preparedness into their disaster plans

50% had the ability to “lock down” the hospital

96% had no awareness of the threat to hospital as primary terrorist targets

H E I C S- A Local Perspective

Hudson County, with a population of 610,000 residents is the most densely populated of New Jersey’s 21 counties

Jersey City, alone, has a surge population of over 1 million people during the day

Brennan Court House- A Hudson County Landmark

Some factors to take into account in disaster planning:

H E I C S- A Local Perspective

The County serves as one of the major transportation hubs in the U.S.A., with direct access to New York City via the Lincoln and Holland Tunnels, PATH and passenger ferries.

The NJ Turnpike, Interstates 78, 95 and 280, routes 1&9 and the Hudson-Bergen Light Rail system all run through the County

H E I C S- A Local Perspective

Hudson County is home to 4 colleges and seven parks, including Liberty State Park and the Ellis Island National Historic Landmark.

H E I C S- A Local Perspective

For all of it’s many public attractions , landmarks and density of population, Hudson County has only 7 hospitals (only ONE of which is a trauma center) to deal with any potential disasters.

Clearly there is a demonstrated need for a comprehensive hospital disaster plan for the Liberty Health System

H E I C S- Current State of Preparedness

Our Disaster Recovery Plan goes something like this…

H E I C S- Establishing the Need

Common problem areas identified in hospital disaster response include:

Communication break down Power failures Water supply depletion

Physical/structural damage HAZMAT exposure Unorganized evacuations Resource allocation

Water supply contamination

H E I C S- Current State of Preparedness

• Must improve state of readiness

• All initial response is local!!

• Training and equipment lacking

H E I C S- Current State of Preparedness

• Lack training & equipment

• Few hospitals are truly OSHA hazmat prepared

• Not well integrated into city and county disaster planning

• Not typically included Not typically included in the “funding loop”in the “funding loop”

H E I C S- What is HEICS?

Hospital Emergency Incident Command (HEICS) is a TOOL to help hospitals manage an emergency incident more effectively and efficiently.

Always use the correct size tool for the job!

H E I C S- What is HEICS?

H E I C S-

»Logical Management Structure»Defined Responsibilities»Clear Reporting Channels»Common nomenclature to help

unify hospitals with other responders

What is HEICS?

The benefits of using HEICS is that the system includes…

H E I C S-

CHO ICES

COSTS

TIME

ISSUES

What is HEICS?

H E I C S- Tell me again WHY we need HEICS…

Because the Regulatory Agencies are here to “help” us.

•OSHA

•EPA SARA Title III

•JCAHCO

•NFPA

•STATE Health Regulations

•Local Health Department

H E I C S- Tell me again WHY we need HEICS…

Hospitals must develop written plans and exercise them twice a year

Plans must cover every employee and every department in the institution

Hospitals must coordinate with Local Emergency Planning Committees (LEPC’s)

H E I C S- What is HEICS?

Based on ICS–Developed and used by fire service in 70s –Used for large and small scale operations

Hospital Council of Northern California –Adaptation of ICS to hospital emergency response functions completed in 1987

»Earthquake Preparedness Guidelines for Hospitals served as cornerstone to HEICS implementation

California EMSA Grants Provided–1991, 1992, 1998 (Third Edition)

H E I C S- What is HEICS?

Based on– Organizational Chart

»Four Branches (Operations, Planning, Logistics, Finance) overseen by an Incident Commander

Clearly Defines a Chain of Command

– Clear Job Action Sheets»Designed to direct the assigned individual in disaster recovery tasks»Job descriptions with list of emergency response tasks

– depending on size and nature of event and staff resources available

H E I C S- What is HEICS?

The end goal of HEICS is to provide comprehensive emergency management in four areas

Preparedness Response

RecoveryMitigation

H E I C S- The Basic Structure

L IA IS O NO F F IC E R

S A F E T Y /S E C UR ITYO F F IC E R

M edical S taff D irector IN F O R M A T IO NO F F IC E R

R E C O R D E RS

L O G IS T ICSS E C T IO N

P L A N N INGS E C T IO N

F IN A N CES E C T IO N

O P E R AT IO NSS E C T IO N

IN C ID E N TC O M M A N D E R

H E I C S- The Basic Structure

The organizational chart structure helps to promote meaningful communication among those managing an incident.

H E I C S- The Five Main Functions

Incident Command Finance Operations Logistics Planning

O perationsChief

LogisticsChief

FinanceChief

P la nn ingC h ie f

In cid en t C o m m a nd er

Note the

H E I C S- The Command Staff

L IA IS O NO F F IC E R

S A F E T Y /S E C UR ITYO F F IC E R

R E C O R D E R IN F O R M A T IO NO F F IC E R

M edical S taff D irector

L O G IS T ICSC H IE F

P L A N N INGC H IE F

F IN A N CEC H IE F

O P E R AT IO NSC H IE F

IN C ID E N TC O M M A N D E R

Function:To define and plan the mission and ensure its completion

H E I C S- The Logistics Section

LOGISTICSRECORDER

DAM AGE ASSESSM ENT& CONTROL OFFICER

SANITATION SYSTEM SOFFICER

FACILITYUNIT LEADER

COM M UNICATIONSUNIT LEADER

TRANSPORTATIONUNIT LEADER

M ATERIALS SUPPLYUNIT LEADER

NUTRITIONAL SUPPLYUNIT LEADER

LOGISTICSCHIEF

Function:To provide an environment and materials for the overall medical objective or incident needs

H E I C S- The Planning Section

SITUATION - STATUSU NIT LEADER

LABO R PO OLU NIT LEADER

M EDICAL STAFFU NIT LEADER

PATIENT TRACKINGO FFIC ER

PATIEN T IN FO RM ATIONO FFIC ER

N UR SINGU NIT LEADER

PLAN NINGC HIEF

Function:To develop the action plan so as to accomplish the medical objectives; collects and evaluates information; maintains the status of resources

H E I C S- The Finance Section

TIM EU NIT LEADER

PR OCU REM ENTU NIT LEADER

C LAIM SU NIT LEADER

C OSTU NIT LEADER

FINANCEC HIEFFunction:

Provide funding for present objectives, and stress facility- wide documentation for later financial recovery

H E I C S- The Operations Section

SURGICAL SERVICESUNIT LEADER

M ATERNAL - CHILDUNIT LEADER

CRITICAL CAREUNIT LEADER

GENERAL NURSING CAREUNIT LEADER

OUT PATIENT SERVICESUNIT LEADER

IN-PATIENT AREASSUPERVISOR

TRIAGEUNIT LEADER

IM MEDIATE TREATMENTUNIT LEADER

DELAYED TREATMENTUNIT LEADER

M INOR TREATM ENTUNIT LEADER

DISCHARGEUNIT LEADER

M ORGUEUNIT LEADER

TREATMENT AREASSUPERVISOR

M EDICAL CAREDIRECTOR

LABORATORYUNIT LEADER

RADIOLOGYUNIT LEADER

PHARM ACYUNIT LEADER

CARDIOPULMONARYUNIT LEADER

ANCILLARY SERVICESDIRECTOR

STAFF SUPPORTUNIT LEADER

PSYCHOLOGICAL SUPPORTUNIT LEADER

DEPENDENT CAREUNIT LEADER

HUM AN SERVICESDIRECTOR

OPERATIONSCHIEF

H E I C S- The Operations Section

M EDICAL STAFFDIRECTOR

M EDICAL CAREDIRECTOR

ANCILLARY SERVICESDIRECTOR

HUM AN SERVICESDIRECTOR

OPERATIONSCHIEF

Function:Conducts Medical Operations to carry out action plan. Directs all direct patient care resources.

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H E I C S- The Operations Section

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M EDICAL STAFFDIRECTOR

SURGICAL SERVICESUNIT LEADER

M ATERNAL - CHILDUNIT LEADER

CRITICAL CAREUNIT LEADER

GENERAL NURSING CAREUNIT LEADER

OUT PATIENT SERVICESUNIT LEADER

IN-PATIENT AREASSUPERVISOR

TREATM ENT AREASSUPERVISOR

M EDICAL CAREDIRECTOR

OPERATIONSCHIEF

In-Patient Medical Branch

H E I C S- The Operations Section

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M EDICAL STAFFDIRECTOR

IN-PATIENT AREASSUPERVISOR

TRIAGEUNIT LEADER

IM M EDIATE TREATM ENTUNIT LEADER

DELAYED TREATM ENTUNIT LEADER

M INOR TREATM ENTUNIT LEADER

DISCHARGEUNIT LEADER

M ORGUEUNIT LEADER

TREATM ENT AREASSUPERVISOR

M EDICAL CAREDIRECTOR

OPERATIONSCHIEF

Out-Patient Medical Branch

H E I C S- The Operations Section

close upclose upHuman

Services Branch

STAFF SUPPORTUNIT LEADER

PSYCHOLOGICAL SUPPORTUNIT LEADER

DEPENDENT CAREUNIT LEADER

HUM AN SERVICESDIRECTOR

H E I C S- The Operations Section

close upclose upAncillary Services Branch

LABORATORYUNIT LEADER

RADIOLOGYUNIT LEADER

PHARM ACYUNIT LEADER

CARDIOPULM ONARYUNIT LEADER

ANCILLARY SERVICEDDIRECTOR

M EDICAL CAREDIRECTOR

H E I C S- The BIG Picture

Public Inform ationO fficer

LiaisonO fficer

M edical S taff Director Safety/SecurityO fficer

Recorder

T imeUnit Leader

Procurem entUnit Leader

ClaimsUnit Leader

CostUnit Leader

FinanceChief

FacilityUnit Leader

Com m unicationsUnit Leader

T ransporatationUnit Leader

M ateria l SupplyUnit Leader

Nutritional SupplyUnit Leader

LogisticsChief

Surgical ServicesUnit Leader

M aternal-ChildUnit Leader

Critical CareUnit Leader

G eneral NursingUnit Leader

O utpatient ServicesUnit Leader

Inpatient AreasSupervisor

T riageUnit Leader

Im mediate TreatmentUnit Leader

Delayed Treatm entUnit Leader

M inor T reatm entUnit Leader

DischargeUnit Leader

M orgueUnit Leader

T reatment AreasSupervisor

M edical CareDirector

LaboratoryUnit Leader

RadiologyUnit Leader

Pharm acyUnit Leader

Cardiopulm onaryUnit Leader

Ancillary ServicesDirector

Staff SupportUnit Leader

Psychological SupportUnit Leader

Dependant CareUnit Leader

Hum an ServicesDirector

O perationsChief

S ituation-StatusUnit Leader

Labor PoolUnit Leader

M edical StaffUnit Leader

Patient T rackingO fficer

Patient InformationO fficer

NursingUnit Leader

P lanningChief

Incident Com m ander

H E I C S- Job Action Sheets (JAS)

One JAS for Each Position Mission (Function) Statement

with Focused Objective Prioritized Activity List To Be Customized to the

Organization (Except Title and Mission Statement)

H E I C S- Job Action Sheets (JAS)LOGISTICS SECTION CHIEF

Positioned Assigned To:

You Report To: (Emergency Incident Commander)

Logistics Command Center: Telephone:

Mission: Organize and direct those operations associated with maintenance of the physicalenvironment, and adequate levels of food, shelter and supplies to support the medicalobjectives.

Immediate ____ Receive appointment from the Emergency Incident Commander. Obtain packet containing Section's Job Action Sheets, identification vests and forms.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Emergency Incident Commander.____ Appoint Logistics Section Unit Leaders: Facilities Unit Leader, Communications

Unit Leader, Transportation Unit Leader, Material's Supply Unit Leader,Nutritional Supply Unit Leader; distribute Job Action Sheets and vests. (May bepre-established.)

____ Brief unit leaders on current situation; outline action plan and designate time fornext briefing.

____ Establish Logistics Section Center in proximity to E.O.C..____ Attend damage assessment meeting with Emergency Incident Commander,

Facility Unit Leader and Damage Assessment and Control Officer.Intermediate ____ Obtain information and updates regularly from unit leaders and officers; maintain

current status of all areas; pass status info to Situation-Status Unit Leader.____ Communicate frequently with Emergency Incident Commander.____ Obtain needed supplies with assistance of the Finance Section Chief,

Communications Unit Leader and Liaison Unit Leader.Extended ____ Assure that all communications are copied to the Communications Unit Leader.

____ Document actions and decisions on a continual basis.____ Observe all staff, volunteers and patients for signs of stress and inappropriate

behavior. Report concerns to Psychological Support Unit Leader. Provide forstaff rest periods and relief.

____ Other concerns:

Job Job Action Action SheetsSheets

H E I C S- Supporting Forms

Forms Help Drive Positions

Aid in Documentation

Activity Log

Action Plan

Personnel time sheet

H E I C S- Position Vests

Valuable for Identification

Valuable for Organization

H E I C S- Emergency Ops Center (EOC)

The Emergency Operations Center (EOC) serves as the “nerve center” of all HEICS activities

H E I C S- Emergency Ops Center (EOC)

Location Supplies Operating Protocols Communications

There are many factors to consider in setting up an EOC

H E I C S- Emergency Ops Center (EOC)

Emergency Operations Centers (EOC) should be highly specialized facilities primarily designed to capture, distribute, and assess emergency information to facilitate rapid and accurate decision-making.

H E I C S- Implementation

Implementing HEICS means taking the time to do it right!

Administrative “buy-in”/support Staff education Adequate resources and funding

H E I C S- Questions?